Published: Synapse 2014, Vol. 1

2014 Vol1_09No night is longer for a parent than one spent with a sick child, and nothing derails a well-planned Saturday afternoon faster than a child's unexpected illness. As any parent knows, typical childhood ailments often happen at night or on weekends when your pediatrician or family doctor's office is closed. What are your options when your child has an illness that can't wait for your pediatrician's normal business hours? If you live in Chester County, you bring your child straight to Chester County Hospital's emergency room where board-certified pediatricians from Children's Hospital of Philadelphia (CHOP) are waiting to give your child the specialized care you are looking for when your doctor is not available.

"Parents often have a natural sense about when their child needs medical care. Certain symptoms create urgency. Parents can bring their children in to see the pediatricians here in our emergency room for illnesses that they feel need immediate attention, when their pediatrician does not have open office hours," explains Betty Brennan, EdD, MSN, RN, CEN, Director of Emergency Services. "We provide the same care available at your doctor's office, along with immediate access to an even higher level of care, if needed. We make sure children are well cared for and comfortable, parents are informed, and families are in and out as quickly as possible."

Hospital-based CHOP pediatricians have always been a collaborative part of Chester County Hospital's Emergency Department (ED) team. Previously, they were on call from the hospital's Pediatric Unit for consultations and to help manage the care of younger patients. Today, they are now on site in the ED itself during the peak hours when urgent care is most needed by children under age 6. Starting this past January, the CHOP pediatricians are based in the ED on weekdays from 7 pm to 11 pm and on weekends from 3 pm to 11 pm. Beyond these ED-specific hours, they continue to be available from the Pediatric Unit around the clock.

CHOP Care Network pediatrician Tiffany Cooke, MD, FAAP, treats a young patient in the ED.

According to Karen Pinsky, MD, Medical Director of CHOP Care Network/Newborn and Pediatric Care at Chester County Hospital, the hospital made a conscientious decision to optimize the care it provides in its Emergency Department for families when their pediatricians are not available. "We looked at patient volumes in the Emergency Department to identify the children by age and by diagnosis that would be best served by an enhanced pediatric process in the ED and how we could make things easier for those families," says Dr. Pinsky. "It made sense to have pediatricians right there in the emergency room to treat young children with the kinds of illnesses that require specialized medical attention."

The CHOP physicians and all the emergency medicine doctors at Chester County Hospital are trained in pediatrics, so they are all experts in dealing with the illnesses and injuries that often befall children. As soon as a child arrives at the ED, they are immediately evaluated by an emergency room physician or physician assistant to assess their injury (ex. fracture, laceration, pain, trauma, etc.) or the acute illness symptoms (ex. high fever, ear infection, flu-like symptoms, vomiting, lethargic behavior, etc.). The child's medical condition and age determines whether their symptoms are treated by a CHOP pediatrician or their injury is treated by an ED physician.

In some situations, a child may come in with a medical condition that can actually be diagnosed and treated during the initial triage stage of the visit, and the family can be on their way home quickly. For example, an ear infection may be easily diagnosed on the spot and an antibiotic provided right there and then. Children with issues requiring further attention go on to see the CHOP pediatrician who will act as their primary care provider for the duration of their visit.

Betty Brennan, EdD, MSN, RN, CEN, Karen Pinsky, MD, and Diana Kane, MD

Pediatric patients are cared for in a designated area of the Emergency Department that is more "kid-friendly." All the equipment, medical supplies and hospital gowns are "kid-sized." And there are plenty of features to keep little hands and minds busy, including DVD players and a collection of family-favorite movies.

"Children are not small adults. They are special to their parents, and they are special to us. Having a pediatric focus in our ED has created a different pathway through the department for our young patients that is centered on their clinical and emotional care, while keeping the needs of their parents also in mind," says Diana Kane, MD, Chair of Emergency Medicine. "Our pediatricians are board certified and specialize in caring for children. They are highly trained, experienced hospitalists with a level of comfort and familiarity that comes from caring for children and their parents on a regular basis."

Because the CHOP pediatricians are hospital-based physicians and also work in the hospital's Pediatric Unit, they are able to provide a continuity of care for children who may need to be admitted for observation or treatment. They also communicate with each child's own primary care physician, providing information about the patient's condition as well as any tests or procedures that may have been performed. In addition, the pediatricians maintain an open dialogue with parents, keeping them informed, providing time for questions, and making sure any fears or concerns are addressed.

CHOP Care Network pediatrician Marc Perlman, MD, and ED nurse Linda Shepard, RN, help provide urgent care in the ED for the hospital's youngest patients. Photo credit: Chester County Life

"An emergency room setting can be an intimidating environment for anyone. The last thing parents with a sick or injured child want to do is subject their little one to a situation that could make them feel even worse," says Brennan.

"We gear everything toward taking care of the child holistically. We do everything possible to reduce or soften the potentially frightening moments for children and parents. And, with pediatricians managing their care, we are able to keep stays as short as possible for our young patients and get them home sooner."

In fact, the new dedicated pediatric focus complements an overall emergency care delivery system that was recently streamlined and fine-tuned by Chester County Hospital to be more rapid and efficient. The hospital completely redesigned the process in its Emergency Department to increase efficiency and keep wait times at a minimum for patients of all ages. Currently, it takes on average only about 9 to 10 minutes for an adult emergency room patient to be seen by an ED physician or physician assistant, and the wait is often even shorter for children.

By Beth Eburn
Photos by Rick Davis

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