Those who design medical facilities do not design homes. So when physicians determine that a medically fragile child can live at home—instead of a complex medical facility—appropriate technologies can make that move home sooner and smoother.

Consider the highly rated reality television show “Extreme Makeover Home Edition.” Many episodes center on families whose children have medical conditions. The design, architecture and features inside each new home illustrate how these children can live fully at home—with the right medical technologies.

Each day, St. Paul-based Pediatric Home Service (PHS) performs home makeovers of its own by embracing innovative technologies to bring kids home for fuller lives. PHS also provides upgrades, maintenance, and other services so each patient has equipment best suited to his or her situation.

“Our patients go to school, playgrounds, soccer games, the State Fair, grandma’s house, cross-country family vacations, and hundreds of other places,” explains Sandi Lutz, Managing Director of Clinical Service, Neonatal/Pediatric Specialist, who has been with PHS since its beginning in 1990. “This mobility is possible in large part because of how we incorporate portable medical technologies in our patient care.”

It hasn’t always been this way.

“When PHS began 20 years ago, we provided home respiratory care. We brought children home on Sechrist IV 100B ventilators,” recalls Steve Roberts, PHS Operations Manager, who has also been with PHS since its beginning. “It was ‘hospital grade,’ and not meant for home use. It required high pressure gas tubing, astronomical electricity and an awful lot of space. The massive oxygen source alone wouldn’t fit in most bedrooms, so we often put it outside. As soon as we knew a child was coming home, we’d visit the home and often make recommendations for necessary carpentry and electrical work. We would run 100 feet or more of high pressure gas tubing throughout the house. We didn’t just want a child home in one room, we wanted to give them the freedom to move and be moved throughout their home.”

Smaller is better
PHS officials agree that for their services and patients, the most dramatic change in medical technologies is the size and portability of equipment. “Ventilators can now hang on a wheelchair or fit in a backpack,” Roberts says. “Before, food pumps had to be upright and attached to an IV pole near the patient. Now infusion systems fit in a backpack.”

“Battery life has also made equipment more portable. Ventilators that once had very short battery life now have seven to nine hours. That’s a great advancement to offer our patients and their families,” Roberts says.

Also in PHS’s infancy two decades ago, a significant challenge was locating medical equipment designed for pediatric patients. Since then, the technology has improved. Today, equipment vendors use PHS as a beta site to test food pumps, infusion setups, ventilators, and other equipment developed specifically for smaller patients and their unique needs.

Beyond respiratory care
PHS cares for children with multiple conditions that require multiple pieces of equipment.

“We now own 185 Pulmonetic ventilators, mainly the LTV 950 and LTV 800,” Roberts says. “Yet we also have complex oxygen systems, physiologic monitors, CPAP and BiLevel systems to mask or trach., infusion therapy systems for hydration, chemotherapy, immunoglobulin and other care, plus we have thousands of pieces of medical equipment and supplies either on hand or within quick access.”

Focused on new technologies
To handle the array and volume of new equipment options, PHS has a New Equipment Integration Process (NEIP) team, specifically centered on carefully evaluating new offerings. Twelve PHS employees, including clinicians, educators, equipment technicians, customer service and operations personnel participate in NEIP, meeting on a regular basis to ensure new products safely meet patient needs.

Besides reviewing new options, the group considers off-label applications and even analyzes equipment suggestions from patients’ families.

“Parents with medically fragile kids are a close network, so when a parent hears about a new product or technology or application from another parent, our NEIP has likely reviewed it and we can provide guidance. Or, we will look into that product for their child,” Lutz says.

“We work with nearly 40 different vendors,” Roberts explains. “Our NEIP allows PHS to be more proactive than ever, requesting varieties of certain equipment and incorporating new products into our care. We also diversify our products in case of recalls or other situations.”

Test, test and test again
PHS has six technicians that are qualified in Pulmonetic and other manufacturers’ certification programs, including one who recently received the National title of Certified Biomedical Equipment Technician (CBET). These technicians thoroughly test each new piece of equipment before it goes to a patient, including assembly, operation, battery function and reviewing product information, and instructions. These PHS technicians also regularly test equipment in more stringent timelines than manufacturers’ recommend. When warranted, PHS replaces equipment promptly.

“Our attention to product testing provides great reassurance for each patient’s family and our prescribing physicians,” Lutz says. “Plus it saves time and eases care for everyone involved in these cases.”

Education is also critical. Bruce Estrem, PHS Education Coordinator, explains: “Our patients are not in a hospital where they can quickly exchange a ventilator or staff within the facility. Our equipment and properly trained home staff must be prepared for the unexpected at all times. We allocate ample resources to train everyone who will be involved with a PHS patient—including parents, siblings, and professional staff—about each piece of equipment through classroom training, user manuals, and our own materials such as the STAR kit.”

Estrem continues, “The first week one of our patients is home, PHS visits daily to assess the home set-up, re-educate as necessary and ensure adherence to a safe care plan in the home. This approach helps us develop a close relationship with the family, which ultimately helps everyone involved.”

Growing on
“PHS has patients who are no longer considered pediatric,” Lutz says. “Yet we continue providing care and equipment sized to fit each patient’s size, needs, and evolving lifestyle.

“I remember one of PHS’s first ventilator patients, an infant boy who was deemed deaf. When his physician said he could leave the hospital PHS figured out the technology and care to get him home safely. Within a few days, he was thriving, and it was clear he wasn’t deaf—just in a shell he’d created,” Lutz recalls. “Today, he’s in high school and doing great.”

She continues, “We’ve enabled kids to go deer hunting with their fathers, experience a Montana fishing trip, even go to Mexico or Europe. PHS’ approach to technology and our motto of ‘say yes’ is enabling kids to live fuller lives.”

Roberts adds, “I’ve seen the new equipment that medical technology companies are developing right now, and I’m excited about the possibilities for PHS to bring even more kids home from the hospital sooner, safely, and smoother than ever.”