Monday, November 30, 2015

What will happen during my child's ER visit?

Hazel Guinto-Ocampo, M.D., chief of pediatric emergency services at Bryn Mawr Hospital, tells you what to expect when you take your child to the ER.

What will happen during my child's ER visit?


We often dread taking our children to the emergency room. It can be a stressful experience for both the child and parent. In a two part series this week, Hazel Guinto-Ocampo, M.D., chief of pediatric emergency services at Bryn Mawr Hospital, talks about how to make the visit to the ER run more smoothly. Yesterday, she gave tips on how to prepare for the ER. Today, you’ll find out what you can expect once you get there and how you can help your child through the visit.

Here is a list of what will likely happen once you arrive at the ER, and tips to make the visit more pleasant and worthwhile.

1. Expect to wait and spend a few hours in the ER. Unlike other doctor visits where you have a specific appointment time, your turn depends on the severity of your child’s sickness, and how many patients are in the ER within the time period you arrive.  

Although most of us think our child is sicker, there is a process called triage whereby experienced ER nurses sort through the patients based on their main signs and symptoms, and the level of care that they would require.This ensures that kids with more life threatening conditions such as breathing difficulty and vital sign abnormality get seen first.  

To add to the confusion, most ERs have a Fast Track or Fast Care area for patients who are expected to get quickly seen, cared for, and discharged.  Examples of conditions seen in this area are cuts, scrapes, bruises, simple broken bones, ear infections, and colds.

2.  Be familiar with the team of providers caring for your child. You will meet several people, often with different roles. The first person you may meet is the greeter. This person will ask for your child's name and date of birth, and the reason for your child's visit. Next, the triage nurse will get a brief clinical history and may check your child's vital signs, which includes pulse rate, respirations, blood pressure, temperature, pulse oximeter,  and weight. The registration clerk will then obtain insurance information, and ask you to sign a document stating you are consenting for your child to be treated. At this point, a bracelet will be placed to verify your child's identity.  Make sure the information is accurate.  An allergy bracelet will also be placed when needed.

Once you are in your room, you will meet your primary nurse who will be caring for your child usually throughout the stay. The nurse will perform and coordinate procedures your child may need, and is your primary source of information. Make sure you know your nurse’s name.  

Next, you will meet the ER physician, or a mid-level provider, or a resident (trainee) physician. Mid-level providers are utilized by many busy ERs and are directly supervised by the ER physician. They may be physician assistants or nurse practitioners.  They are skilled providers who have often undergone additional training in emergency medicine. They are very skilled in performing time-consuming procedures such as repairing cuts, or applying splints.  

If your child's visit requires specialty care, you may also meet consultant physicians.  One of the most common misconceptions about ER visits is that every consultant physician is physically present and readily available. In fact, although most can be reached by phone via an on-call system, very few are available to come to the ER. A surgeon will come in if your child should need a surgical procedure immediately, such as an appendectomy for acute appendicitis.  Other consultants can provide advice on the telephone or can be available for a follow-up visit, if required.

You may meet other ancillary providers. These can include ER technicians, x-ray technicians, or a respiratory therapist. Most children's hospitals employ a child care professional who will help your child through uncomfortable or painful procedures.

3.  Advocate for your child's safety. Your child should wear an identification and an allergy bracelet, if needed.  Make sure every provider acknowledges your child's name, and checks your child's identity before tests or procedures are done, and checks your child's identity and allergy history before any medication is given.  Your child should be weighed in kilograms since most medications are weight-based and calculated on a kilogram basis.

4.  Advocate for your child's comfort. If your child is in pain, ask for pain medication.  Realize that your child's providers are experts in providing pain relief, and should have the best options for your child.

5. Do not hesitate to ask questions. If you are not comfortable with the plan of care for your child, ask about other options. If you are still unsure, you can try to contact your primary care physician for advice.

6. Try to plan ahead. Ask your ER physician or the physician’s designee for the approximate length of your visit. Realize that this time frame may change, depending on your child's need for additional tests, consultants, or treatments.

7.  Be prepared to wait some more.  It may seem like after an initial flurry of providers, then you wait again. This is usually the time when the providers are waiting for your child's test results (a standard blood tests usually takes 45 minutes to 1 1/2 hours to process), or waiting for your child's response to a treatment.  If your child needed special tests like X-rays, ultrasound, or CT scan, these will add even more to your waiting time since the test may require preparation, and a radiologist may need to review and interpret them.  Feel free to ask your primary nurse for updates regularly.

8. Understand the discharge instructions for your child. These could include prescriptions, what to watch out for, when to arrange a follow-up visit with your child's primary physician or specialist, and when to come back to the ER.

9.  Be vigilant.  After discharge, continue to monitor your child’s progress and response to treatments.  Your child was evaluated during a single point in the illness and conditions can change anytime.  If your child seems worse, call your primary physician or the ER.  If you are unsure of what to do, always err towards getting your child re-evaluated either by the child’s primary physician or back in the ER.

10. Take the time to provide feedback. Most hospitals mail surveys to a random number of patients following an ER visit.  If you receive one, please take the time to fill it out.  People who run their ERs need to know what they are doing well and what they need to improve.

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Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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