Clinical Component

Navigating the Clinical Component

The pediatric surgery team provides a wide spectrum of surgical services in a state-of-the-art facility designed for efficiency and optimal patient outcomes. The team specializes in managing trauma cases for patients 12 and under and procedures span a variety of conditions, including congenital anomalies, abdominal and thoracic surgeries, tumors, and emergency care. ECMO services are provided and CHOG is one of only two centers in the state offering this critical care option. Transplant surgeries are not part of the practice scope.

There is currently volume for 3.5 FTE, but the group wants to have 4 FTE to maintain a healthier lifestyle and be able to increase our availability to patients.

The department operates with a mix of half-day clinics and full-day operating schedules, with surgeons typically conducting two to three days of surgery and one to two half-day clinics per week. This ensures a manageable workload, even with the high volume of surgical cases currently handled by the team.

  • Surgery: 2-3 full days a week
  • Clinic: 1-2 days half day per week
    Typically see 50-60 patients with 2 providers and up to 90 with 3 providers
    25 feet away from the OR (Clinic, ORs, NICU, PICU are very close to each other)
  • Advanced practice providers (APPs) play a vital role in supporting the surgical team. While they do not participate in surgeries, they are integral in care coordination and clinic operations, ensuring smooth workflow and patient care and continuity.
  • Typical Day: Start at 7:30am end at 5pm
  • EMR: EPIC 

SURGERY

  • Dr. Pipkin currently operates 5 days a week and does clinic every day, which makes for a long day. This is not sustainable long term, and he will return to a normal schedule once another surgeon joins the team
  • Big surgeries are done together - team doesn’t leave until everyone’s cases are complete
  • Current surgeons will mentor candidates in areas they may feel deficient
  • Typically 2 surgeons scrub in on difficult cases
  • Each surgeon has a PA for surgery (doesn't operate)
  • There is an APP for trauma
  • The resident’s scrub into surgery

Surgical Team: There is an anesthesiologist, a surgeon, a resident, a nurse, a technician, someone that cleans the room and the recovery team. This creates a culture of safety where anyone can speak up. No hierarchy. Patient safety is number one for everyone.

CALL

The on-call structure emphasizes balance and quality of life. Surgeons are on home call, supported by residents who handle first-call responsibilities. This structure allows for rest and recovery during off-call periods. The surgical department fosters a collaborative culture. In the operating room, all team members, including anesthesiologists, nurses, and technicians, work together as equals, maintaining a “team-first” philosophy. This ensures safety and quality care while creating an environment of mutual respect.

  • Call is from home
  • Residents are in house and take first call
  • 15 Minute response time for surgeons
  • You will take everything that comes in
  • You will have no other responsibilities, and nothing scheduled the day post call
  • Surgeons come in to do surgery at night for emergency cases, ECMO or a surgical trauma
  • Surgeons don't come in for non-operative consultations.
  • Surgeons won’t come in to do cases like an appendectomy, they will be done the next morning if they can wait

Anesthesia

  • 8 Pediatric Anesthesiologists (have hired the 2025 fellow to bring staff to 9)
  • Open communication between anesthesia, nursing and the pediatric surgeons. The anesthesia team works very closely with the pediatric surgeons. All are very approachable and know each other well.
  • Utilize CRNA’s and AA’s in care delivery, there are 2 AA’s in Pediatric Anesthesia
  • Anesthesiologists have a 30-minute response time for call as the anesthesiology resident is in house and will get things moving while the attending is in route

Pharmacy

In-house pharmacy with meds to beds program.

Operating Rooms

The hospital’s operating rooms are meticulously planned to minimize the distance between critical areas, such as the operating suites and the clinic, fostering seamless patient care. Surgeons benefit from excellent turnaround times in the operating rooms, averaging just 20 minutes. This ensures operational efficiency and allows for higher case volume when needed. 

  • 10 ORs (2 procedure rooms) with plenty of OR time.
    Pediatric Surgery works in our new OR 7 and 8 rooms.
  • Preop and post op area for the children
  • There is good turnaround time that averages about 20 minutes

PICU

  • 14-bed closed unit
  • 6 bed step down unit
  • Covered by Pediatric Intensivists
    Pediatric surgery patients get admitted to their service
    Pediatric traumas are admitted to the pediatric surgeons due to the ACS trauma requirement and Pediatric Intensivists co-manage patients
    Pediatric Surgeons and Intensivists have excellent relationship
  • Currently remodeling to add 8 additional ICU beds
  • Average length of stay is 3.4 days.
  • 994 (2.7 per day) admissions October 1, 2023-October 1, 2024
  • Neurological issues are always in the top 5 diagnostic categories.
  • ECMO: One of two ECMO centers in the state of Georgia; ECMO is done in the OR, PICU and the NICU. The pediatric surgeons put the patient on the ECMO and the intensivists manage them. The ECMO program was started by Dr. Howell in the 1980s. It was the first program in the southeast. Completed more than 500 ECMO’s since 1986.
  • Separate Ped CVICU from the other sick kids.
  • Pediatric Hospitalist service works a 7on/7off schedule. They are in house during the day and available at night from home.

NICU

  • Level 4 Open NICU; 45 Bed; Unit A and Unit B
  • Neonatology Team: 7 Attendings, 12 NPPs and 6 fellows, (2 per year).
  • Schedule: Saturday – Friday, 2 attendings on at a time. An NP runs Unit A, a resident runs Unit B. There are 2NPs and a fellow on at night in each unit. Residents are on during day. Attendings are on call from home at night. (This has helped the fellows gain a better understanding of how a private practice Neonatology position might work, as they will be overseeing the NPs in our A unit).
  • Pediatric surgeons round in our NICU every afternoon. At that time the surgeons address the non-urgent questions from the NICU staff.
  • The team works closely with the pediatric surgeons and the Piedmont Level 3 NICU across the street. There is a large catchment area including Aiken, SC with our pediatricians staffing their newborn nursery.

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