By Dr. Paul Sirbaugh, chief of pediatric emergency medicine, and Dr. Katherine Leaming-Van Zandt, pediatric emergency medicine specialist at Texas Children’s Hospital
Emergency Center overcrowding is a crisis nationwide for hospitals and the communities that they serve. This is especially true in large cities like Houston where the population is experiencing rapid growth.
Because it is critical for emergency staff to treat the sickest children first, often times families who come in with non-emergent complaints wait hours before seeing a doctor. Many of these parents are unaware that there are more appropriate medical-care options closer to home that provide quality care in a fraction of the time.
We don’t want to discourage parents from acting against their instincts in seeking care, but there are resources available to help decipher when and where to seek treatment. Last year at Texas Children’s Hospital we had more than 114,000 patient visits to our Emergency Center (EC), but, staggeringly, more than 25 percent of those visits could have been treated elsewhere.
One important aspect of a successful healthcare model is the medical home. All children from the time they are born should have one. This ensures families have access to preventive care and a place to turn to when they need medical attention, instead of using ECs as their first or only option. Having a dedicated medical home allows families to build meaningful relationships with pediatricians who can help them determine how to appropriately seek primary, urgent or emergency care for their child.
We feel strongly that, if parents embrace this model of care, leaving the ECs to treat true emergencies and allowing the child’s medical home to address the colds, ear aches, sore throats and other common ailments we currently see in the EC, this will help alleviate wait times. Furthermore, we encourage families to get in front of illnesses by being more attentive in the role they play in preventing their child’s illness (e.g., flu vaccines) or injury (e.g., helmets and seatbelts).
That being said, knowing when and when not to take your child to the emergency center can be a difficult and stressful decision for many parents. Some examples of when you should take your child to the emergency center:
- breathing difficulties (including rapid breathing or increased work of breathing/shortness of breath),
- altered or abnormal behavior such as lethargy (difficult to awaken), confusion, agitation,
- persistent vomiting and/or diarrhea AND dehydration (no tears with crying, dry lips/mouth, pale skin, no urination in more than eight hours),
- swallowing a foreign body and difficulty breathing, drooling, vomiting or pain,
- fever and neck stiffness,
- deep/gaping or persistently bleeding cuts,
- broken bones, or
- head injury and loss of consciousness, severe headache, vomiting or abnormal behavior/activity.
However, as mentioned before, if your ill/injured child is awake and interactive and you’re uncertain of the level of care that your child needs, you should call your child’s pediatrician, nurse’s hotline or Poison Control Center for further advice. Although the EC is open all day every day and seems the most convenient or fastest choice, many childhood illnesses/injuries can be treated at home or by seeing your child’s pediatrician the next day.
For those children who do have medical emergencies, it’s important that parents be aware of what to bring to the EC to make the trip run more smoothly. Unless you go to a hospital where your child’s medical information is readily available, many EC physicians cannot access your child’s medical record. So, when going to the EC, it’s very important to bring a copy of your child’s: medical information (with past and current medical issues/diagnoses and surgical procedures); vaccination records; medication and food allergies; and current medications (prescription and non-prescription).
Also, you may want to bring some toys/activities, comfort articles, and snacks for you and your child.