Pediatric ED seeks to touch all the bases
Advanced courses prepare staff
The "child-friendly" environment of the pediatric ED at Medical University of South Carolina (MUSC) Children's Hospital in Charleston is a dead giveaway as to the kind of patients the department sees.
All rooms are private, each decorated to follow a different theme, such as animals, fish, or boats. Every room also is equipped with a TV, VCR, and DVD player. Another unique aspect of the department is the presence of child life specialists, who are on hand to help ease the fears of the young patients and make them feel more comfortable.
But that's just one aspect of a staff geared toward this patient population. All staff members have received specific advanced training that helped prepare them to recognize and cater to the specific medical needs of children.
"We are designated as a Level I trauma center, and that includes both adult and pediatric patients," explains Melanie Ann Stroud, RN, the trauma coordinator. "The official term is an adult trauma center with pediatric consideration."
The ED nurses care just for children, adds Debbie Browning, RN, MSN, nurse manager for the pediatric ED. "There is no back and forth between the two [adult and pediatric] EDs," she says, "and all our physicians are board-certified attendings in pediatric emergency medicine."
The department's physicians are trained in advanced trauma life support, which is a fairly intense course, says Stroud. The nurses are trained in the Trauma Nurse Core Course (TNCC).
"We also do additional training with our nurses in relation to pediatrics," she says. For example, they are certified in pediatric advanced life support (PALS).
In addition, all the RNs take the Emergency Nursing Provider Course (ENPC) "which teaches them to recognize sick children," says Browning. "It is very specialized in the unique care of children up to age 18."
Stroud says, "Children are very unique patients in that they have anatomical differences, there are certainly more emotional family concerns, they will react differently to traumatic situations, and they have a high incidence of post-traumatic stress syndrome [PTSS]," she says. "Children are very resilient and heal faster in terms of injury, but some studies show they do suffer from PTSS."
For these cases, the child-life therapists and full-time social service worker are of great value, says Stroud. "They identify families and patients who might not be able to react well to injury or other issues — like a parent who was killed in the same accident — and can get them into proper treatment after discharge," she explains.
The child-life specialists, who are available during the busiest hours (11 a.m. to 11 p.m. or 1 a.m. to 1 p.m.) seven days a week, are "master's-prepared, with strong backgrounds in child growth and development," says Browning. So, for example, if a child is about to have an IV started or any other procedure that seems threatening or frightening, the specialist will prepare the child in terms they will understand, explain to them how they can participate and help, and actively involve the parents. "So instead of having to hold a child down, the parents can support them while we start the IV," Browning explains. These "comfort holds" involve the parent helping to hold an arm or snuggle the child on their lap. "It makes the procedure a whole lot less threatening," Browning says.
The department also has respiratory therapists who are capable of managing a child's airway. "They are smaller in a child," Stroud explains. There is a pediatric surgeon on staff, who can perform procedures in the ED or determine that the child needs to go to the OR, and a pediatric intensivist in the pediatric ICU who can care for children in a trauma bay or help out in the ED.
Improving safety
Browning is convinced that the care in the pediatric ED is superior to the care children receive in a 'nonspecialized' ED.
"It is safer and better, very much so," she says. "We have a group of nurses who know what a sick and well child looks like, who can make those triage decisions, go back and reassess if their condition changes, and have a strong desire to be there and care for children." In many EDs where adult and pediatric care are combined, "you will find that some nurses are not comfortable with or like caring for children," she says.
Shortly after the department opened, says Browning, an ED operations committee was established to look at throughput and related outcomes. The committee consists of representatives from nursing, physicians, respiratory therapy, child-life, and registration, plus additional departments on occasion as needed. Although the department's volume has increased 67% in the past four years, the length of stay "is right at 2.5 hours, right where we started," she reports. (For information on how the hospital has accomplished this feat, see story, left.)
Sources
For more information on pediatric EDs, contact:
- Debbie Browning, RN, MSN, Pediatric ED Nurse Manager, Medical University of South Carolina, Charleston. Phone: (843) 792-8557. E-mail: [email protected].
- Melanie Ann Stroud, RN, Trauma Coordinator, Medical University of South Carolina, Charleston. Phone: (843) 792-5806. Fax: (843) 792-6776. E-mail: [email protected].
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