Faculty members and fellows from the Division of Hospital Medicine and Complex Care. Front row, left to right: Sarah Webber, MD; Kirstin Nackers, MD; Mary Ehlenbach, MD; Laura Chen, MD; Heidi Kloster, MD; Ann Allen, MD; Jonathan Fliegel, MD; Dan Sklansky, MD. Second row, left to right: Haroon Ali, MD, fellow; Ryan Coller, MD, MPH; Kristin Tiedt, MD; Sabrina Butteris, MD; Michelle Kelly, MD, PhD; Ebba Hjertstedt, MD, MS; Heather Peto, MD, MPH; Kristin Shadman, MD; Cris Ebby, MD; Nikki St. Clair, MD, MS; Brian Williams, MD. Photo by Bob Gordon/Department of Pediatrics.
Late last year, the Department of Pediatrics Division of Hospital Medicine expanded its name to the Division of Hospital Medicine and Complex Care. This division of professionals whose primary work involves caring for patients while they are hospitalized has seen the nature of its work shift in recent years. According to Ryan Coller, MD, MPH, associate professor and chief of the division, the name change aligns with the evolving health care needs of the division’s patients, particularly those with medical complexity, as well as the academic work taking place in the division, including education of learners, research, and quality improvement.
The name change also closely aligns with an important milestone: the 10-year anniversary of the creation of the Pediatric Complex Care Program within the division. This program provides medical management and care coordination for children with medical complexity who are served by UW Health Kids. Children with medical complexity have diseases affecting many organ systems, see many specialty teams, have frequent hospital admissions and specialty clinic visits, and do not have a diagnosis-specific forum for coordination of their care. The physicians and advanced practice providers within the Pediatric Complex Care Program share the clinical workload: seeing children in the inpatient and outpatient settings, communicating with families and health care providers, and coordinating care.
Mary Ehlenbach, MD, associate professor and medical director of the Pediatric Complex Care Program, described the division’s name change — incorporating “complex care” — as a natural and logical decision.
“It makes sense to highlight more visibly — and externally — that this work is happening within the hospital medicine division,” she said. “The comprehensive care of children with medical complexity also extends well beyond the walls of the hospital, and our program has been offering interprofessional collaborative care to children with medical complexity for years. Changing the division’s name better reflects the depth and breadth of the services we provide.”
The Division of Hospital Medicine was established within the Department of Pediatrics in 2009. The field of hospital medicine, whose professionals are called “hospitalists,” was emerging at the time. Ellen Wald, MD, professor in the Division of Infectious Diseases and department chair from 2006 to 2022, recognized the opportunity to establish a pediatric hospital medicine service shortly after her arrival at the UW. “It was becoming clear that the complexity of pediatric in-patients was increasing and that primary care practitioners couldn’t reasonably be available to coordinate the care of those patients,” Wald explained.
Furthermore, with the opening of the new state-of-the-art American Family Children’s Hospital (AFCH) in 2007, more children from regional areas were coming to AFCH for care. The work of the pediatric hospitalist was becoming more important; it was the right time to make this expansion of the department.
Ehlenbach joined the young division in 2011. Coller joined two years later. Both were experienced pediatric hospitalists who had a special interest in children with chronic medical conditions who were admitted to the hospital over and over, especially those with medical complexity.
“There was a growing recognition that children with medical complexity were a unique population,” Ehlenbach explained. “Their care needs, by nature of the multiple different chronic conditions, were different than children with a single specialty chronic condition.”
Wald noted, “Both Ryan and Mary had a passion for these children and a vision that if a special service were created for them, their health conditions could be managed more successfully.”
The Pediatric Complex Care Program launched in March 2014 with Ehlenbach as its medical director and Coller as its research director. The initial team also included Kristan Sodergren, NP, who shared in the clinical work of coordinated care for patients and families both during their visits to the UW and from home. In 2020, Heidi Kloster, MD, associate professor and associate residency program director, joined the Complex Care team as its education director, followed by Brittany Storhoff, NP, in 2023, and most recently Brooke Mortensen, NP, in April 2024.
Since it began a decade ago, the Pediatric Complex Care Program within the division has served more than 520 families of children with medical complexity. Nearly 300 patients are currently enrolled, and over 125 patients are on a waiting list for the program.
The entire Division of Hospital Medicine and Complex Care has grown to include 17 faculty members and nine clinical staff members. Four years ago, it launched the two-year Pediatric Hospital Medicine Fellowship. It welcomed its first fellow in July 2022. Today, the division’s providers care for nearly half of the pediatric inpatients at American Family Children’s Hospital (AFCH).
The physicians who choose to practice hospital medicine and complex care do so with eyes wide open and a deep understanding of the unique challenges families face when caring for a child with complex medical needs. Michelle Kelly, MD, PhD, professor in the Division of Hospital Medicine since 2009, explained the impact of the Pediatric Complex Care Program. “The program has introduced a more holistic approach to how we care for children with complex health care needs,” she said. “We now deliver more comprehensive care that extends beyond our hospital walls — ensuring continuity of care from the hospital to the home with the help of a network of dedicated health care providers and community services.”
Kelly noted, “The name change reflects our evolving practice and commitment to addressing the broader needs of our patients.”
“Because our population of hospitalized children is disproportionately medically complex, the skills required are even more specialized. These children depend on multiple devices, the care of multiple specialists, and very sophisticated home-based care,” Coller explained. “This is increasingly the population of children at American Family Children’s Hospital, both present and future.”
Because so many of the division’s practitioners address so much more than the title “Hospital Medicine” implies, Coller believes that the new title will more clearly identify — and announce — the true nature of their vision and focus, knowledge and expertise, as well as their passion as physicians.
“The new title accurately and uniquely identifies us,” Coller explained. “First, we want to honor and respect a critical and unique population of patients and their families that we take care of. Second, we want to remind ourselves, as physicians, that this is challenging work, and that we choose this work, we are committed to this work enough to call it out in the name.”