Code Pink and Blue It's the middle of the night and your child is ill or injured. Your family doctor closed his doors hours ago, but your child must get medical attention. Your choices are slim. Most people have only one place to turn - the dreaded emergency room.
When it comes to pediatric care,how does your hospital fare?
Even though most people have a horror story to tell of an ER, they remain extremely reliant on them. Adding to the trepidation of an ER visit is the fact that some ERs are not at all prepared for a pre-adolescent patient. Recently, Child Magazine published a brief questionnaire titled Evaluating Your ER. The questions it posed, which were aimed at preparing you for what you will encounter in an ER, were developed by Dr. Joel Cohen, the Mesa, Ariz.-based physician and author of ER: Enter at Your Own Risk, and Dr. Stanley Inkelis, director of the American Academy of Pediatrics subcommittee on pediatric emergency care in non-children's hospitals.
The Times posed the questions to seven local hospitals: Doctors' Hospital, Lafayette General Medical Center, Medical Center of Southwest Louisiana, Opelousas General Hospital, Our Lady of Lourdes Regional Medical Center, University Medical Center and Women's & Children's Hospital. Although our local hospitals came up short in some areas, they fared well overall.
Sometimes, because of the severity of an illness or injury, parents can't be picky about their children's ER and must opt for the closest one. But for patients with a less severe injury, the questionnaire provides the pros and cons of these ERs.
The first question on the list was, "Does the ER have a separate area for children?" Only UMC and Women's & Children's had a separate ER area for pediatric patients. Opelousas General also has one, but only on the weekends.
You might not think a separate area for kids is important, but do you want your child in an ER next to a gunshot victim or someone involved in a serious car accident?
"Having one area for both children and adults has two major drawbacks," says Cohen. "First, that means the same doctor and nurse who treat adult patients will treat the children. In most hospitals across the country, the pediatric training and experience of that doctor and nurse will be minimal - perhaps an internist or family doctor, both of which are not experts in child care. Even general emergency medicine trained physicians only spend about 13 percent of their training on treating sick children.
"Second, children will more likely be exposed to the 'ugly side' of emergency rooms with trauma patients, drug abusers and others who paint a picture in ERs not suited to young children."
The question of who treats children in the ER also appeared in Child's questionnaire. The Times asked the local ERs, "Who is on hand to treat pediatric ER patients? Are they regular doctors or are they doctors that specialize in the emergency care of children?" Once again, only Opelousas General, UMC and Women's & Children's had the correct answer. At Opelousas General, there is one pediatrician who will come in if one of his private-care patients is admitted to the ER. UMC's answer was that it has a pediatrician on call but not readily available. And, Women's & Children's staffs pediatric-specific ER doctors.
Although all hospitals reported having ER-certified doctors, these doctors might lack the bedside manner and patience needed to deal with juveniles says Cohen, adding that this problem is not limited to Acadiana.
"If all of the ERs had a specialist trained in pediatric emergency care, what a wonderful world this would be!" says Cohen. "Considering less than 100 (pediatric specialists) are trained annually, these specialists are a luxury to children's hospitals and some university hospitals. The majority of hospitals are not pediatric specialty hospitals, however. The experience and training of doctors, nurses and even medics who treat children in dire straits is sadly unpredictable and variable.
"Clearly, lack of physician and nurse expertise in treating the varied needs of sick children implies that our emergency care system for children is less of a priority than treating adults."
The Times also asked the hospitals "Who does triage in the ER? Is it doctors and nurses or technicians?"
Most hospitals answered that it is a nurse who determines the severity of a patient's injury. Only Medical Center of Southwest Louisiana responded it has both nurses and doctors doing triage in the ER.
When asked, "Do you have all the necessary pediatric-specific equipment?" all hospitals responded that they did. Pediatric-specific devices - such as child-sized defibrillators (shock paddles) - are required to be in every ER.
The last question on Cohen's and Inkelis' list - "Do you have a child life program?" - was the stumper. In fact, no hospital on our list knew what a "child life program" was. A child life program is designed to make a child's ER visit a little less traumatic. The program usually utilizes a child life expert who helps prepare the patient for their visit. The specialist may playfully introduce the child to the medical instruments used in the upcoming procedure to set the child at ease. They might also help parents and siblings cope with their grief before visiting a sick loved one, offer support or assistance to the family and help with bereavement if necessary.
Cohen states that because ER visits are so brief, many hospitals view a child life program as insignificant. However, he pointed out that even the most fleeting ER visit can have severe long-term traumatic effects on a child.
Even though the local ERs had some shortcomings, Cohen gave them decent marks based on the survey. On the basis of their responses, he graded all the hospitals at a B level, except for UMC and Women's & Children's, which both received an A-.
However, Cohen acknowledges the ERs' stumbling blocks are larger than Acadiana.
"Most ERs get by with frequent miscues in care," he says. "Until the overcrowding and understaffing crises in our ERs are addressed, tragic errors in care will continue. More pediatric specialists need to be trained as well - but all this costs money that isn't easily available. All doctors and nurses should be required to take pediatric advanced life support courses as they must take advanced cardiac life support."
Asked if he would take his children to one of these ERs, Cohen responded, "I would keep my children out of the ER and have my pediatrician evaluate them first, if at all possible. Critically ill or injured children may fare better if treated at a children's or university hospital."