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"While other hospitals around the coun- try are experiencing decreased patient volumes, we are seeing massive growth in patient numbers and in the number of patients requiring surgery," he says. One reason for this growth is the hospital's agreement with MetroHealth Medical Center in Cleveland. Five of the six pediatric surgeons rotate between Children's Akron campus and MetroHealth where they provide 24/7 emergency and inpatient coverage. They also offer clinics twice a week there, and perform inpatient and outpatient surgery, including thoracic, gastrointestinal, and abdominal surgery. "The long-term desire is to strengthen our partnership and expand the pediatric services we offer at MetroHealth," says Dr. Parry. "Right now, we provide cardio- thoracic surgery, cardiology, hematology/ oncology, and critical care for pediatric patients. It certainly keeps our pediatric surgery group busy." Akron Children's Beeghly Campus in the Mahoning Valley also contributes to the growth in surgical patient volumes. Dr. Soldes provides outpatient surgery services there twice a week. "We see children for all conditions — inpatient, outpatient, minor, major — in the Kikel Center for Pediatric Surgery in Boardman," he says. "If the patient needs inpatient surgery, we do the surgery at our Akron campus. But outpatient surgical care is offered at our Beeghly campus where it's more convenient for patients and their families." While the surgeons rotate among the three sites, Akron Children's Advanced Practice Providers (APPs) service ensures continuity of care. The APPs include six nurse practitioners and six physician assistants, all of whom are stationed at the Akron campus providing outpatient coverage for same day appointments, in addition to 24/7 coverage of inpatients and first assistant coverage in the OR. According to Dr. Parry, who developed the innovative APP service, it's been very beneficial. "I think this is a unique model that's not in use anywhere else. Having an APP service to improve outpatient access and continuity in the inpatient area is a tremendous asset for our program." Also underway is a $200 million expan- sion on Children's Akron campus. The centerpiece of the project is a medical care building which will house six additional outpatient surgical suites to accommodate the more than doubling of outpatient procedures seen in the past 20 years. Construction is expected to be completed in January of 2015. New Concepts The majority of surgery cases at Akron Children's are done on an outpatient basis, and most are minimally invasive — lapa- roscopic, endoscopic, and needlescopic. Once considered cutting edge in pedi- atric surgery, single incision laparoscopic surgery (SILS) is now practically routine at Akron Children's for appendectomy and gall bladder removal. Dr. Ponsky, who reportedly was the first in the world to perform SILS in a child and publish the experience, is researching how to adapt other adult surgical techniques for use in neonates, children, and adolescents. The goal is to make surgery less invasive and reduce scar size. "We're trying to perfect the NOTES (natural orifice translumenal endoscopic surgery) technique for esophageal atresia, a relatively common congenital defect in which the esophagus is not connected to the stomach," he explains. "With NOTES, surgery is done through the mouth, so it's scarless." Dr. Ponsky is also trying to perfect PHOTO © SMITHBERGER PHOTOGRAPHY, NORTH CANTON Robert Parry, MD, is Director of Pediatric Surgery at Akron Children's. Recently, Dr. Parry created an Advanced Practice Providers (APPs) service to provide outpatient coverage for same-day appointments, along with 24/7 coverage of inpatients and first assistant coverage in the OR. 2 0 1 4 M AY/J U N E ■ M D N E W S . CO M ■ MD NEWS Cleveland/Akron/Canton | 1 3