The Road to OZ: Taking Care Beyond the Bedside for Really Sick Kids | Nick Holekamp | TEDxStLouis | Summary and Q&A

September 25, 2023
TEDx Talks
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The Road to OZ: Taking Care Beyond the Bedside for Really Sick Kids | Nick Holekamp | TEDxStLouis

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In this video, Mr. Nick Polkamp, a pediatrician, discusses the impact of hospital environments on children with medical complexity. He emphasizes the need for hospitals to be more developmentally stimulating and less isolating for these children. He introduces the concept of a bridge hospital for children, where play is the central therapeutic element. Through this innovative model of care, children are encouraged to get up and out of bed, resulting in significant progress and benefits for their physical, behavioral, and developmental well-being.

Questions & Answers

Q: What impact does the hospital environment have on children with medical complexity?

The hospital environment can have a significant impact on the growth, development, and learning of children with medical complexity. These children, who rely on technology and medical support, often have to spend long periods of time in the hospital. Being hidden inside hospitals, they become almost invisible to the majority of the population. Up to 80% of these children end up with significant developmental delays, highlighting the need for hospitals to be more supportive and nurturing to ensure their overall well-being.

Q: How can hospitals be made more developmentally stimulating for these children?

To make hospitals more developmentally stimulating for children, we need to imagine a hospital environment that inspires them to get out of bed and engage in activities. The key is to create an environment that keeps them safe but also encourages them to actively participate in their recovery. One example is the concept of a bridge hospital for children, where play is the central therapeutic element. By incorporating play, children are motivated to get up, interact with their surroundings, and engage in activities that promote physical, cognitive, and emotional development.

Q: What is the concept of a bridge hospital for children?

A bridge hospital for children is a unique model of care that focuses on providing care beyond the bedside. It is a hospital where play is considered the most important and effective treatment for children. This model aims to give children who have been through serious illnesses and surgeries the opportunity to catch up on the time they lost when they were sick. By ensuring they have places to learn, communicate, and play, the bridge hospital provides a stimulating and supportive environment for their recovery.

Q: How has the bridge hospital helped children like Lisa?

The bridge hospital has made a significant impact on children like Lisa. Lisa was born with life-threatening heart defects and spent the first 14 months of her life in Intensive Care. Despite multiple surgeries and being on life support, there was little more that could be done medically. However, the bridge hospital provided Lisa with opportunities she wouldn't have had anywhere else. Through play and engagement, Lisa became stronger, got off the ventilator, and eventually recovered beyond expectations. Her story showcases the transformative power of a developmentally stimulating hospital environment.

Q: Why is it important to get these children up and out of bed?

Getting children up and out of bed is crucial for their well-being and recovery. Lying in bed all day is not conducive to their physical and developmental progress. The more these children can engage in activities and actively participate in their recovery, the more progress they can make. By providing opportunities for them to be active, learn, and interact with others, we can maximize their quality of life and ensure better outcomes for them.

Q: How does the bridge hospital ensure the safety of these children?

The bridge hospital prioritizes the safety of these children wherever they are. They practice a "Do no harm" approach, which means they take whatever equipment and support the children need with them, even when they are out of bed. It is like an ICU on wheels, where they ensure the children have access to ventilators, feeding pumps, suction machines, and oxygen tanks, along with extra supplies in case of emergencies. They also conduct regular mock code exercises to ensure the staff is prepared for any emergency situation, whether inside or outside the hospital.

Q: How did the study on hospital environments for children with medical complexity help improve their care?

The study conducted on children like Lisa aimed to understand where they are and what they are doing throughout the day. The study found that these children spend a significant amount of time out of bed and out of their rooms compared to other hospitals. However, it also revealed that a considerable portion of their awake time is still spent in bed, which is not sufficient for their development. This led to the establishment of a structured group developmental programming for young children within the hospital, focusing on optimizing their neurodevelopmental recovery and providing a more stimulating environment to counter the developmental limitations caused by medical complexity.

Q: What is the Optimization Zone?

The Optimization Zone, also known as the "Oz," is a specially designed program within the bridge hospital that aims to optimize the neurodevelopmental recovery of medically complex children. It is a structured educational and therapeutic programming for children ages five and younger. Staffed by educators, therapists, and volunteers, the Oz follows a schedule with themes of the week, including music, art, letters, numbers, shapes, and colors. Similar to a preschool environment, the Optimization Zone provides children with opportunities to enhance their cognitive, physical, and social skills, offsetting the negative impact of a developmentally stifling hospital environment.


Mr. Nick Polkamp's discussion highlights the need to create developmentally stimulating and supportive hospital environments for children with medical complexity. By prioritizing play and active engagement, hospitals can significantly impact the physical, behavioral, and developmental well-being of these children. The concept of a bridge hospital for children, such as the one mentioned in the video, demonstrates the positive outcomes that can be achieved when children are encouraged to get up and out of bed. Incorporating structured developmental programming, like the Optimization Zone, further enhances the neurodevelopmental recovery of these children. It is essential to continue advocating for and implementing such approaches to ensure a higher quality of life and better outcomes for these children across all healthcare settings.

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