Pediatric emergency department: Where kids come first
Pulse editor
Sunday, February 15, 2009
Kristie Vance tells her friends to drive the extra miles to find a pediatric emergency department when their children need urgent care.
“They’ll find it makes all the difference,” she said. “In a pediatric ED, the doctors and nurses are more comfortable working with children because they are experts in this patient population. When the focus is on kids, they don’t get lost in the shuffle as they might in a regular emergency room.”
Photos by BARRY WILLIAMS / AJC Special
Heather Howard examines Addison Lytle at WellStar Cobb Hospital’s pediatric emergency department as her mother, Karla Carpenter, holds her.
Cobb WellStar Hospital’s pediatric emergency department uses the pod system, in which treatment rooms ring the nurse station, making it easier for nurses to treat their young patients.
Vance, RN, BSN, works in WellStar Cobb Hospital’s pediatric emergency department in Austell, one of a handful in Atlanta. Other pediatric emergency departments in metro Atlanta are at Children’s Health Care of Atlanta at Scottish Rite, Children’s Health Care of Atlanta at Egleston, Hughes Spalding hospitals and WellStar Kennestone Hospital.
Vance, the mother of two, started her career in WellStar Cobb Hospital’s emergency department, but switched to the pediatric emergency department five years ago.
“I was ready for a change and had been picking up shifts in the pediatric ER,” she said. “The teamwork I saw here brought me to this department.
“These are an amazing group of people, and the teamwork is exceptional. The pediatric doctors are confident and competent, and the nurses are all certified in pediatric advanced life support.”
She believes the hospital’s staff and systems deliver the best and most efficient care possible.
“You never know what is going to walk through the door, but having board-certified pediatricians see them is better for patients and parents. They are more familiar with what happens to children and know what is a big deal or not a big deal,” said Heather Howard, RN, BSN, SANE. “We see everything, from an ear infection to a bead up the nose to full cardiac arrest. Working here definitely keeps your skills sharp.”
The newly expanded facilities at WellStar Cobb have more beds and parking, and are designed to serve the growing pediatric population in south Cobb and surrounding counties. WellStar Cobb’s pod system helps the staff provide efficient care.
“I don’t know what other hospitals use, but we believe the pod system is the most efficient way of treating young emergency patients,” Howard said.
As soon as patients sign in, they receive a medical record number and are placed in a pod (a room with a bed) if one is available.
“They receive care from a triage nurse who, following protocols, can immediately order tests and treatment as needed,” Howard said. “In this way, the patients aren’t on top of one another [or left in a waiting room]. There’s less noise and distraction, and that helps us give better care.”
The rooms are designed with under-the-sea décor and are equipped with TVs. Scary alarms and sounds are kept to a minimum.
The pods are arranged in a circle around the nurses’ station, making it easier for nurses to keep an eye on patients. “We don’t have to waste a lot of time walking up and down halls,” Howard said.
Doctors see patients quickly and often can pull up test results or X-rays from computers to help make diagnoses. If possible, patients are treated in the rooms, but more critical cases are admitted to the pediatric unit of the hospital or stabilized and transported to another facility.
The pediatric ED is open 18 hours a day; the average turnaround time for patients is an hour.
“We recently had a young basketball player admitted with a fractured nose at 8:15 in the morning,” said Vance. “I heard the dad tell his son that they would probably be there until 2 p.m. or later.
“The doctor had the films by the time he saw the boy — we have digital images so you don’t have to wait for films to be developed — and could order pain and swelling-control medication and decide whether the child needed to see an ENT (ears, nose and throat doctor) for surgery. The patient was discharged by
10:30 a.m., so we definitely exceeded that family’s expectations.”
People often have the misconception that all patients should be seen right away in an emergency room but, due to high patient numbers, the national average for being treated is six to eight hours, she said.
“We obviously always try to do our very best, but some situations are more challenging,” Vance said. “You feel helpless when there isn’t much you can do to allay parents’ fears. You always want to make things better, but sometimes the outcome isn’t what you want and all you can do is hug the parents.”
Howard said staff members enjoy interacting with young patients and often bring stickers and Popsicles to make them more comfortable, but that the first priority is to deliver safe and appropriate care.
“Thanks to our safety-first initiative at WellStar, we are in the habit of checking two patient identifiers before administering any procedure,” Howard said.
Howard, who is studying to be a pediatric nurse practitioner, finds the pediatric ED an excellent learning ground.
“It trains me to take care of families, who are worried and need reassurance as much as the patients, and the kids are always so appreciative when they feel better,” she said. “Sometimes there’s instant gratification when you can fix something immediately, but it’s always rewarding.”