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Children's Emergency Department offers acute, primary care by Heather Woolwine Public Relations The tone in his voice deepened, signifying the seriousness of the matter shared between patient and doctor. As Olivia Titus, M.D., turned her attention to Erick Westbury, 4, she knelt at the boy’s level and described a sinus and allergy medication that he would need to alleviate symptoms brought on by complications of mononucleosis.   “Will it get all my boogers out?” the child asked solemnly.   Dr. Olivia Titus, left, Erick, and his mom, Rachel, share a laugh while discussing Erick's care in the Children's ED. Stifling a giggle and reasserting her stance, Titus said, “Yes, Erick, it will get all your boogers out.”   Breaking into wide grins, the two friends touched foreheads as they reveled in Erick’s relief.   Since the MUSC Children’s Emergency Department (Children’s ED) grand opening two years ago, patient volumes are up 20 percent as parents of the Lowcountry realize that the best emergency care for their child can be found in the skilled and capable hands of the Children’s ED staff.   Unlike any other pediatric facility or emergency room in the area, the Children’s ED staff is specifically trained in pediatric emergency medicine. Children and emergency medicine are their expertise. While other facilities may staff a pediatrician in the emergency room, having a physician licensed in pediatric emergency medicine is another story.   These physicians are equipped to handle any emergency situation a child may face, whereas pediatricians do not receive trauma training. By the time a pediatric emergency physician begins to practice in an emergency room, he or she has undergone more than 10 years of rigorous training. Nurses with specific training also complement the child-friendly atmosphere. They work closely with child-life specialists to make sure that a trip to the emergency room is as non-threatening as a trip to the grocery store.     Like most emergency rooms these days, the Children’s ED sees a combination of acute and primary care needs. This translates into a care system that places the sickest children first in receiving appropriate medical treatment.   Every patient that arrives at the Children’s ED sees a pediatric triage nurse who completes a brief history and assessment of the patient. As one of the strongest nurses in the unit, he or she has the responsibility of gauging the immediate need for care. The staff of the Children’s ED knows that parents are concerned and even distraught when they arrive at the front door, and that’s why they are dedicated to evaluating and treating every child as quickly as possible.   “One of the reasons I originally chose MUSC’s ER was because the Children’s Hospital was listed as one of the top 10 Children’s Hospitals in the nation in a magazine (Child),” said Rachel Bresnihan, Erick’s mother. “They’re so friendly here and we can talk to the doctors easily. The last time we were here was when Erick was dehydrated because of the mono, and we were scared when we got here. They did everything so well and so quickly; even his intravenous. They explained everything to Erick and in a way that he could understand about his medicine, and why it was so important to take it… That helps me out at home, a lot.”   When Erick thinks of the Children’s ED, one thing comes immediately to mind—Power Ranger stickers. He also likes how his doctors talk to him; that they tickle him and make him laugh; and that they smile a lot. But more than anything, the stickers have him convinced that the Children’s ED is a good place.   Bresnihan has another perspective, in addition to her maternal instinct, when it comes to choosing care for her son. She works for a medical malpractice firm. “We defend doctors and hospitals in their medical malpractice suits and from what I’ve seen at work and experienced by bringing Erick here, MUSC is an all- around good choice.”   Bresnihan cited short waiting times, the availability of a full staff and the quickness of necessary medical testing as other advantages to visiting the Children's ED.     Experiences like Bresnihan’s and Erick’s are exactly what the Children’s ED is aiming for, according to Debbie Browning, R.N., Children’s ED nurse manager, and Joseph Losek, M.D., Pediatric Emergency Care section chief.   “Our goal is to be very child-and-family friendly, and that means understanding the differences in caring for children ranging in ages from birth to 18 years old,” Browning said. “One of our biggest assets is child life, and they do a phenomenal job of helping the children while they’re here in the department. We’re working with the Children’s Hospital pain management coordinator to make this department as pain-free as possible. [We] are currently in discussions about the best way to expand our services to meet the growing community need.”   “This is a multidisciplinary effort,” Losek said. “We work closely with pharmacy, respiratory therapists, social workers, and medical and surgical pediatric subspecialty physicians to coordinate emergency care and get all of the necessary experts to the bedside.”   Losek offered several tips for families to keep in mind while receiving treatment at the Children’s ED: The initial evaluation, or triage, is not meant to be a detailed assessment. Triage actually means to sort, and in this case, it means to sort the acutely ill from the less acutely ill. Those who need immediate care will be seen first, while those who can wait a few minutes can go through a more standard registration process. The triage nurse is a very skilled and experienced nurse who makes that decision.  It’s very helpful for the ED staff to know what medications a child has taken or uses on a regular basis. It’s not always easy to access records from other facilities, so the more information that parents can provide about a child’s medication and allergies, the faster and easier it will be to treat that child. Parents should remember that MUSC is a teaching facility, so there is a good chance that a child will meet a medical student, a resident physician, and an attending physician, unless the child is very ill. This is an extremely valuable experience for the student and resident, and also provides two additional people to think about and evaluate a child’s medical needs. The attending physician always monitors the child in addition to these two staff members. Parents should know that the ED staff is constantly trying to lessen wait times and make the ED experience as pleasant and smooth as possible. In fact, the Children’s ED has a list of standing orders so that when a child presents certain symptoms or pain, a nurse can begin treatment immediately to make the child comfortable until a physician is available for an examination. The Children’s ED also has a fast track program called Quick Care. From 6 to 10 p.m. on weekdays and 4 to 10 p.m. on weekends and holidays, patients with less acute problems or illnesses can be seen in the Children’s ED fast track unit. For instance, instead of waiting two to three hours for a regular office appointment, or having to take off work, parents can bring a child into the fast track and receive service and treatment much faster than traditional methods.   “We’re always working to find ways to decompress the ED and this was something that would not only help us do that, but it provides a great service to patients,” Losek said.   Ultimately, what makes the children’s ED so special is its commitment to focusing on children and their needs. One size never fits all, and the cliché couldn’t ring more clearly than for those most vulnerable in the health care system.   “Children suffer from different diseases and different injuries than adults, so it makes sense that their care should be different,” Losek said. “The most common emergencies in children are respiratory illnesses, as compared to adults who have heart problems. Injuries that occur in children are the result of blunt trauma (falls, car accidents) and adults suffer more often from penetrating trauma (guns, knives) that requires immediate surgery.”   Losek further described how exams and evaluations must differ for children, and elaborated on the reasons for having separate adult and child emergency rooms. “   Adults that end up in the emergency room may be intoxicated, using foul language, in pain, and could be physically dangerous. Do you want your six-month old treated in that environment? And conversely, do you want your grandmother treated for heart failure next to a crying six-month old?” he said.   For additional information about the MUSC Children’s ED or other Children’s Hospital topics, visit http://www.musckids.com.     Friday, June 23, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.