Pint-sized Patients, Full-sized Care

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Meeting the Needs of Young Patients and Their Families

Children’s hospitals play an important role in the healthcare delivery system, but only about 220 of them exist in the United States, or less than 5 percent of acute healthcare facilities nationwide. So when children need emergency care, parents often rely on a community hospital.

How can these non-children’s hospitals meet the needs of their youngest community members? And if they can’t financially justify staffing a dedicated pediatric unit, what else can they do to be ready when sick children come through their doors?

Reggie Washington, M.D., has practical answers for hospital leaders asking these important questions. The chief medical officer of Rocky Mountain Hospital for Children (RMHC) at Presbyterian/St. Luke’s Medical Center in Denver, Colorado, for the past six years, Washington has dedicated his career to pediatrics. He has been a private practice pediatric cardiologist for 30 years with HealthONE, an affiliation of seven hospitals in the Denver metropolitan area, and serves as a clinical professor in the department of pediatrics at the University of Colorado Health Sciences Center.

MAKE A PLAN

According to the April 24, 2013, issue of the International Journal of Emergency Medicine, children account for almost 20 percent of all emergency department visits in the United States. However, many emergency departments in community and rural hospitals lack specialized pediatric care. Developing a pediatric plan is the first step for community hospitals looking to increase their skill set in accommodating and caring for young patients.

“Plan ahead for the worst that could happen, just like you would with any disaster plan,” Washington advises. “A sick child coming in may deteriorate very quickly, so you have to be ready for anything.”

To be prepared, a facility must take three major steps:

  1. Make an identification checklist

In 2009, the American Academy of Pediatrics (AAP), the Emergency Nurses Association and the American College of Emergency Physicians created a checklist designed to guide emergency departments in deciding if they’re prepared to treat children, which includes:

  • Appointing a pediatric physician and nurse coordinator
  • Integrating a pediatric patient care review process into the emergency department’s quality improvement plan
  • Implementing ways to develop professional competencies in a variety of areas, such as airway management, pain assessment and treatment, and critical area monitoring—and creating ways to track those competencies
  • Establishing awareness of unique pediatric patient safety concerns in policies and practices, such as making sure everyone knows to weigh children in kilograms and record that figure in a prominent place on the medical record
  1. Invest in training

Lack of experience with pediatrics, challenges with performing technical procedures on children and difficulties calculating medical doses for children can all contribute to patient safety errors. Talk to your staff to determine who, if anyone, has experience working with pediatric patients. Make sure your nurses are trained in pediatric advanced life support, and ensure some nurses have specific training in pediatric emergency care, suggests Shareen Taylor, director of obstetrics and perinatal services at Twin Cities Community Hospital in Templeton, California.

  1. Get the right equipment—and know how to use it

Do you have the necessary supplies and medicine in your emergency department to stabilize and treat pediatric patients? Does your supply chain budget accommodate the purchase of those supplies? According to the AAP, hospitals need resuscitation carts that contain “readily accessible, easily identifiable, necessary weight- or length-appropriate emergency drugs and resuscitation equipment with easily readable lists of pediatric drug dosages.” In addition, the AAP recommends that facilities have defibrillators designed for pediatric use, scales and stadiometers for both infants and older children, and thermometers and blood pressure monitors for the full spectrum of pediatric patients. But hospitals don’t just need to keep these materials in stock—nurses and physicians must know how to use them.

“Facilities need to have the necessary equipment and training, and practice simulation of high-risk, less-frequent events for pediatric patients,” Taylor says.

ASK FOR HELP

Rocky Mountain Hospital for Children has more than 200 pediatric subspecialty physicians on staff and, as part of the HealthONE system, helps better position affiliated hospitals to care for a child who arrives unexpectedly. For example, RMHC offers affiliates a detailed training manual telling them what equipment to keep in stock, where to keep it and how often it needs to be replaced.

Washington notes that his team also checks in with affiliated hospitals every two years to make sure they’re still on track. “We want them to always be prepared for child-related emergencies,” he explains.

Washington encourages leaders at hospitals not yet affiliated with a children’s hospital to seek out such connections. HCA, for example, can connect community hospitals within its system to children’s hospitals for help, and hospitals in other networks can contact their corporate leaders for assistance.

“Whatever you do, definitely reach out and benefit from others’ expertise,” he says.

Doctors and nurses working at hospitals in remote areas can also connect to pediatric specialists at other facilities via telemedicine technology using a live, interactive audiovisual link. Together, they can decide the best way to proceed in caring for a child—including evaluating the necessity of transporting the patient to another facility.

“A benefit of telemedicine is that staff at a non-children’s hospital can start treatment while waiting for a transfer team,” Washington says.

KNOW YOUR LIMITS

No matter how well prepared community hospitals may be, there will be times when they need to transfer patients to a children’s hospital for more specialized treatment.

The Children’s Hospital Association reports that 11 percent of inpatient admissions to children’s hospitals are patients who are transferred from community hospitals.

Washington suggests a list of possible situations when hospital staff might decide it’s better to transfer a young patient: severe infections, unstable heart rate or blood pressure, unconscious without a defined cause, and the need for a subspecialist (such as a pediatric cardiologist or pediatric neurologist) only available at a children’s hospital.

RMHC has developed a set of criteria making it clear when a child requires transfer, Washington says. When it forms new affiliate relationships, it also ensures those hospitals set up patient transfer agreements. That way, when the need to transfer a patient arises, an established protocol is already in place.

“A lot of time and effort is saved when no one has to figure out who to call or what to do on the spot,” Washington says. “Those seconds can really count when it comes to a young patient’s health.”

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