(Little) Emergencies

Here’s the 411 on where to go for a pediatric 911.

(page 2 of 3)

The comforts

A blue sky and white clouds decorate the treatment area’s ceiling. Emergency equipment, such as oxygen canisters, is hidden behind artwork created by students at Bethesda’s Ashburton Elementary. In addition, each room holds a flat-screen TV and DVD player, and staff can access stuffed animals, toys, books and popsicles for patients.

“The kids and their parents are in a state of anxiety when they come in, so whatever we can do to distract them and make them feel comfortable helps ease fears,” says Charlotte Savarino, a Kensington resident and pediatric nurse who has been at Suburban since the pediatric center opened in 2003. Savarino encourages parents to keep fears to themselves so their children don’t become more frightened.

A child who is admitted moves only a few steps to an inpatient bed in the same center, rather than transferring to another floor with new doctors and nurses, as is customary. “A sick kid can go right to a comfortable bed and settle in,” says Dr. David Reitman, Suburban’s chairman of pediatrics who lives in D.C. “The transfer happens in a matter of minutes versus having to wait sometimes hours in some other places.” 

What to be prepared for

You may spend some time in the ER lobby, which is also a waiting area for adult ER cases and lacks kid-friendly distractions. So bring your own. You also can ask if there’s room to wait in a small play area back in the pediatric center, which is stocked with some toys and a TV tuned to kids’ shows.

Suburban does not have an intensive care unit for kids, so critically ill patients who require intensive care will go elsewhere. Other potential transfers include children requiring complicated pediatric procedures, such as an appendectomy for a child under age 2.

Shady Grove Adventist Hospital Pediatric Emergency Department

9901 Medical Center Dr., Rockville

Number of patients seen  in 2009: 27,182
Number of beds: 18

The care

Pediatricians and emergency medicine physicians man Shady Grove’s pediatric ER around the clock. All of the ER’s full-time doctors and the majority of its part-time doctors also specialize in pediatric emergency medicine.

Shady Grove has a number of pediatric subspecialists on staff, as well, who are available to consult with the ER, including pediatric surgeons, pediatric neurologists, pediatric anesthesiologists and pediatric radiologists.

And it has a designated inpatient pediatric unit for children admitted to the hospital from the ER, a pediatric surgical/post-op unit, a pediatric intensive care unit and a neonatal intensive care unit, which limits the need for transfers. The idea is “being able to handle nearly every child’s needs from soup to nuts,” says Dr. Scott Freedman, the pediatric ER’s medical director and a Potomac resident.

The check-in

At registration, a clerk takes a patient’s chief complaint and sends urgent patients immediately to a nurse for further evaluation and then to a treatment room. Patients with less serious complaints may wait a few minutes to see the nurse for an initial assessment, and then may spend time in the ER waiting area. Patient volume and the severity of the illnesses of the other patients at that time can affect how long non-urgent patients wait before being seen by the doctor.

“On a July morning, it may be under 10 minutes. And on a January evening, it could be a couple of hours or more,” Freedman says. Generally, early mornings and summer months are slower, he says. But it’s unpredictable. “I don’t even recommend that you call and ask if we’re busy,” he says. “In the next moment we may get a critical patient…and you may have to wait.”  

If there’s time, have your family pediatrician call and let the ER doctors know what to expect, to help smooth the process. “If there’s any kind of subspecialist needed or radiology procedure needed, I can call ahead and let [the department] know what to anticipate,” says Dr. Julian Orenstein, a Shady Grove pediatric ER physician and Rockville resident.

The comforts

Newly renovated in 2009, Shady Grove’s pediatric ER features a bright, welcoming space with funky patterns on the floors. Books, stickers and popsicles are available, and each treatment room holds a TV and DVD player.

The pediatric ER’s waiting area is separate from the adult ER lobby and includes a large fish tank and a polka-dotted couch that faces a TV playing cartoons.

What to be prepared for

Although most patients who come to the pediatric ER stay at Shady Grove until the end of treatment, some are transferred to other facilities. For example, a patient with cancer or kidney failure may be transferred to an area hospital with additional pediatric specialists, such as Children’s.

Holy Cross Hospital Pediatric Emergency Center

1500 Forest Glen Road, Silver Spring
Number of patients seen in 2009:
Number of beds: nine

The care

Holy Cross’ pediatric ER is staffed by pediatricians who either have a specialty in pediatric emergency medicine or are in the process of acquiring specialty certification. In 2009, the ER went from 20-hour-a-day pediatrician coverage to 24-hour coverage, seven days a week.

Several pediatric subspecialists are on site, including a pediatric anesthesiologist, a pediatric plastic surgeon and a pediatric radiologist. In addition, Holy Cross has a neonatal intensive care unit for infants 3 months and younger, and its specialists will come to the ER to help with infant care. There’s also a designated pediatric inpatient unit for patients admitted to the hospital from the ER.

Holy Cross takes advantage of nearby Children’s when needed. “We have a close, personal relationship with them, which tends to make transfers and things like that easier and smoother,” says Dr. Mark Roddy, a Holy Cross ER pediatrician and Glen Echo resident who used to work at Children’s. The Children’s transport team usually picks up patients who require specialty care within 30 minutes to an hour. Children’s pediatric subspecialists also are on call for Holy Cross.

The check-in

Like many ERs, Holy Cross has families sign in at a registration desk, then see a nurse who determines how quickly the patient needs to be seen by a doctor. During busy hours, however, a nurse also walks the line at the registration desk and pulls out serious cases. An advanced-practice nurse, who has completed extra graduate training, may start treatment and order lab tests. On average, she sees patients within 25 minutes, according to Dr. Diane McDonald, who heads the pediatric ER.

“I can’t guarantee that you’ll have a room in the back within 25 minutes, but we make every effort to have your child seen quickly, and we’ll start treatment during the nurse assessment if possible,” she says. “For example, if someone needs anti-nausea medications, we’ll give the medications during the assessment and start hydrating the patient in the lobby until a bed opens up in the back.”

Bringing current medications and a medical history, as well as calling ahead to your pediatrician, can help smooth the process, particularly if a child has special needs, says McDonald, who frequented ERs herself 10 years ago when one of her children had cancer (her child is now cancer-free). “[A pediatrician] may call me and say, ‘I have so and so and I think they have X, Y and Z. What’s your situation today?’ ” she says. “Then I’ll advise them on how to proceed.”

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