An analysis of waiting times in a pediatric emergency department

Waiting times in a pediatric emergency department were studied using direct observations of patients and health providers on 14 separate days. The mean waiting time (from entry to first physician contact) of the 216 children studied was 49 minutes. Time spent in the waiting room was increased by both the nonavailability of a nurse and the nonavailability of an examining room, and was decreased by the severity of the patient's illness. Time spent in the examination room waiting for the physician was related to the availability of the physician and the number of patients concurrently registered in the emergency department as well as the severity of their complaint. Recommendations for decreasing waiting time, based on the observations, are made. Although each setting is unique, the study provides a model for the analysis of waiting patterns in similar facilities.     

Simulation in the pediatric emergency department

Simulation provides a means to educate, monitor, evaluate, and potentially document the competency of emergency physicians. The evolution of high-fidelity simulators has led to a surge of enhanced medical applications that fit nicely into the core of emergency medicine training. Simulation can facilitate training in resuscitation, procedures, CRM, and mass casualty management. Although improved outcomes from simulation are not well established, there is a general consensus regarding the added value over current training. And finally, simulation provides the ability to construct training to match the current educational efforts related to individual physicians or system-level improvements in communication and patient safety.     

Professional liability in a pediatric emergency department

The risk of professional liability resulting from care given in the pediatric emergency department is a growing concern. This retrospective study examined the patients, diagnoses, and outcome of all threatened and actual claims that originated in the emergency department of a pediatric teaching hospital from 1977 through 1988. Twenty-five cases were identified by the hospital risk manager from approximately 320,000 visits (8.0 cases/100,000 visits); 22 charts were available for review. Ages of the patients ranged from 2 weeks to 13 years (mean 2.9 years, median 3.0 years). The patients' payment status was private insurance (n = 10), state public aid (n = 5), and no third-party payment source was listed for 7 children. Ten patients (46%) visited the emergency department between midnight and 8:00 AM, when an attending physician was not present. Return visits within 2 weeks for the same complaint occurred in 10 cases. The majority of the patients were discharged home (n = 18), and all of them had appropriate, adequately documented discharge instructions. The final diagnoses fell into four general categories: minor trauma/abuse (n = 7), neoplasms/chronic illnesses (n = 7), infectious diseases (n = 6), and appendicitis (n = 2). Review of the charts before knowledge of the legal outcome raised quality-of-care issues in 41% of the cases (n = 9).(ABSTRACT TRUNCATED AT 250 WORDS)     

Medication errors in a pediatric emergency department

OBJECTIVE: To initiate investigation into the medication errors that occur in a pediatric emergency department. These errors have the potential for significant morbidity and mortality, as well as costly litigation. METHODS: We conducted a retrospective chart review of all medication and intravenous fluid errors identified in a pediatric emergency department through incident reports filed over a 5-year period. An attempt was made to determine who was involved with the errors and what caused the errors. The patient outcomes were noted and classified according to clinical significance using previously published criteria. RESULTS: Thirty-three incident reports involving medication or intravenous fluid errors were analyzed. Most errors occurred on the evening and night shifts. Nurses were involved in 39% of reported errors; the nurse and emergency physician were jointly involved in 36%. The most common error was an incorrect dose of medication (35%) or incorrect medication given (30%). In one third of the cases, the family was not made aware of the error. In 12%, patients required additional treatment, and one was admitted to the hospital because of the error. There were no deaths. CONCLUSION: Incorrect recording of patient weights leading to an incorrect medication dose and failure to note drug allergy are common causes for medication errors in the pediatric emergency department. Incorrect drugs and i.v. fluids are given because of similar names and packaging. Many of the errors in the ED seem to be preventable.     

Delirium in the pediatric emergency department

Clinical presentations in the pediatric emergency department (ED) are frequently complicated by acute changes in mental status consistent with delirium. These patients may be considered management problems because of persistent oppositional and aggressive behavior, or may be depressed because of a flat, anhedonic, or unresponsive appearance. As a consequence of the delirium, their management is complicated by an inability to cooperate or participate in their own care. The subjective experience for the patient is also distressing because they frequently recognize the deterioration in their own behavior and cognitive skills. These patients can be effectively diagnosed in the ED, and appropriate treatment recommended and initiated.     

Ultrasound equipment for the pediatric emergency department: a review

Ultrasound is gaining momentum for use in the pediatric emergency department. It is important to understand the fundamentals of ultrasound equipment as it relates to pediatric emergency medicine.     

规范儿科急诊预检与分诊

分析儿科急诊预检分诊的国内外现状,阐述急诊预检分诊的目的及正确实施预检分诊在急诊医疗服务中的重要性,提出对儿科急诊预检分诊的建议和设想.     

Patient complaints in a pediatric emergency department: averting lawsuits

All emergency departments (EDs) receive complaints from patients and their families. Consumers of pediatric emergency care are becoming more astute about the care they receive, and the malpractice climate is rapidly changing. In order to improve patient care services and reduce the frequency of lawsuits, it is crucial that pediatric emergency medicine physicians become facile at preventing and managing such complaints. All ED physicians should have a well-defined complaint management process in place. Lessons learned from the complaints should be shared with the ED health care providers. Complaints can illustrate the deficiencies in the provision of care and serve as an opportunity for improvement.     

Predicting pertussis in a pediatric emergency department population

Cases of pertussis, a potentially life-threatening illness in infants younger than 6 months of age, are at a 40-year high. Children frequently present to emergency departments for initial evaluation. Quick recognition of the illness allows rapid triage, isolation, and prevention of nosocomial transmission. A retrospective, case-control chart review was conducted of pediatric emergency department patients (0 to 18 years of age) presenting between January 1, 2003, and December 31, 2004. Analysis focused on the exploration of medical history and physical examination variables as predictors using laboratory verification of the presence of pertussis as a binary outcome variable. Infants younger than 2 months who have a cough or choking associated with cyanosis, as well as a cough and rhonchi on physical examination, have a high likelihood of pertussis and should be identified in triage, isolated immediately, and tested for pertussis. This may lead to appropriate therapy for this population and decrease the transmission of pertussis to other patients and staff in the pediatric emergency department.