Understandably, every parent who brings their child through an Emergency Department feels their child is quite unwell. Unfortunately, some children are sicker than others, requiring more immediate help. In Canada, standard guidelines help the doctors and nurses identify and see the sickest children first, while still seeing all the children who need help in a timely manner.
A national committee of both nurses and doctors regularly meet to review the guidelines on how to best treat sick children. How do doctors and nurses decide who to treat and in what order to treat them? They do this by:
Getting their first impression of how serious the illness or condition is.
Talking to the child and parents about why they came to the hospital.
Checking ‘vital signs’ (for example: blood pressure, pulse rate) and a physical exam.
The initial assessment of a patient by any staff member in the Emergency Department is called
“triage.” Triage in its simplest terms means ‘to sort’; in a hospital this refers to sorting which child is the sickest, so a doctor can see him or her more quickly. In the Alberta Children's Hospital, this job is done by a senior nurse. Triage nurses identify what problem the child is having and decide how serious the problem is. They are not expected to provide a diagnosis, but with very sick children, they will usually start some form of therapy such as providing oxygen. Also, a set of vital signs are usually taken at this point; this could include temperature, pulse rate, weight, and possibly, blood pressure and a measure of oxygen in the blood. Not every child will get a full set of vital signs. Sometimes, the triage nurse will also do a brief physical examination. The nurse will record this information, along with some information about what happened, and any relevant physical findings.
Depending on that assessment, after triage the child and family may be taken straight to a room to be seen, or they may be asked to sit in the waiting area until they are called. It is important to realize that people are not seen in the order in which they were seen by the triage nurse. Patients asked to wait have not been forgotten and they will be seen in due course.
It is also important to know that your child's condition may change while in the waiting area and s/he may, in fact, be sicker than initially thought or, you may feel that the condition has changed while waiting. Parents are strongly encouraged to approach the triage nurse again in these situations and your child will be reassessed. You are also welcome to have the child reassessed more than once, if you feel that the condition has changed.
Once a child has been assigned a room, the triage nurse or a colleague will escort you, and any family members you have with you, to the room. Rooms are grouped together with one or two nurses covering them. These nurses will likely get a brief summary from the person escorting you; s/he will also have all the information that has been recorded in your chart. Typically, the nurse from the area will reassess your child, including possibly getting more information from you, repeating vitals and/or a physical exam. On occasion, a nurse will start some form of therapy, usually in discussion with one of the doctors who will be looking after your child. In some instances – for example, if your child has a suspected broken bone – you may be sent for an X-ray before being seen by a doctor. In addition, the nurses are there to answer questions and provide information. Nursing staff may have specific instructions for you in certain situations; for example, you may be asked not to give your child anything to eat or drink if s/he will need to be put to sleep with an anesthetic.
An Emergency doctor will then see you. Your child may be seen first by a resident and/or a medical student who will then consult with the attending Emergency physician. More information is usually gathered and a more thorough physical examination performed. Tests may also be ordered, if necessary. Each test is explained to parents as well as why the test is needed. In most instances, children are sent home with or without a prescription and some advice for the parents. Sometimes they will be asked to return later for a follow-up review or to attend another clinic in the hospital. In other instances, a consultant will be contacted by telephone; s/he may give advice or want to see you and your child. Occasionally, a child will need to be admitted to the hospital for further tests, therapies or another specialist's opinion.
Most children seen at the Alberta Children's Hospital do not get admitted. If the Emergency physician feels that your child needs admission, s/he will contact the specific physicians who would take care of your child while in the hospital. This process involves meeting a senior resident, an attending and often, a medical student. At this point, there are often more questions asked and the physical exam is repeated. Your child will be assigned a bed on one of the inpatient units which can take some time to be prepared, especially if the hospital is full and a room needs to be cleaned. Occasionally, the new physicians taking over your care will ask for additional tests which may be done in the Emergency Department, or later on the inpatient unit. When the bed is ready, you will be escorted by a porter to your room.
There are times in the day and days of the week that are busier than others; these will all affect how quickly children can be seen.
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