Yesterday was a day that verified one of my suspicions: when the weather is crappy, pediatric emergency rooms quiet down a lot, but the kids who show up are the ones who need to be there.
Normally, a shift in the ER involves convincing around 2/3 of the one billion people that you see that their kids don’t need to be seen in the emergency setting, and helping the other 1/3 get the acute care that they need. Yesterday, though, it was raining cats and dogs in New York City, and inside our ER, the volume of patients was drastically lower than normal. Instead of the usual big pile of blue (meaning non-acute) charts, the bins for the green (semi-acute) and red (acute) charts kept us occupied. I ended up admitting almost every single patient I saw to the hospital, including two infants with meningitis, a toddler with a big pneumonia, a four year-old heart transplant recipient with a fever, and an adolescent with seizures; the other residents who were on also admitted three asthmatics, two toddlers with croup, an adolescent with a large abscess, another adolescent with an incarcerated hernia, and an infant with recent heart surgery and pallor.
The moral of the story? On rainy days, it’s possible to see how a pediatric emergency department should operate — acute care for acutely-ill children.
I’m sure you already know this - but as a parent, sometimes the difference between what is an emergency and what isn’t is not as clear cut. I remember when my daughter was about 4 months old - she had a bad cold which was actually RSV (didn’t know it at the time). At one point she was going through a bad time, I called the doctor (they had a nurse on call at the time) - she told me to call 911 - 911 sent an ambulance that came and took us to the ER… the whole time I was so self-concious that I was over-dramatizing a cold.
When we got to the ER they told me I did the right thing coming in - that’s when they told me she had RSV and her oxygen levels were really really low. It’s so hard to tell…
• Posted by: Jennifer on Oct 13, 2002, 10:14 PMMost E.D.’s are used where a QuickCare “Doc-In-A-Box” type outpatient office would be a better resource.
• Posted by: Mike on Oct 14, 2002, 11:21 AMJennifer, I didn’t mean that the grey zone should be less grey; you did the right thing, and in cases when you don’t know what the right thing is, calling your doctor can’t be a bad thing to do (which you also did!). The things that drive me a little nuts in the ER are the children who have had their symptoms for weeks or months and haven’t even thought about going to their regular doctor. Another (real) example: a father who brought his daughter in for her first period “because I don’t know how to talk to her about it” — and did so by EMS.
And Mike, the most irritating thing is that we do have an urgicare center right across the street from the ER!
• Posted by: Jason on Oct 14, 2002, 11:31 AMHA! Yeah, I can see your point. That’s pretty scary!
• Posted by: Jennifer on Oct 14, 2002, 2:09 PM