by Amanda Meyer
Child Life Specialist

A visit to the Emergency Department is usually filled with unknowns.  It might be new and unique environment to you and there are many different procedures, protocols, and medications that may be used. You are always encouraged to ask questions, especially if there is something you don’t understand or need repeated. I thought it might be helpful to create a dictionary of common words used in the ED. As always, it doesn’t HURT to ask!
 
Things you may hear in the ED:

Abscess: an area or bump that is infected (sick)
Afebrile: no fever
Arm board: soft pillow that goes under the arm/hand to hold it straight
Blood draw: procedure to take a small amount of blood from a vein to use for tests
Bolus: A large amount medicine given through an IV
Cast: A solid plaster mold that is used to keep a bone from moving 
Cast Saw: A machine used to remove and cut off a cast (very loud but does not cut skin)
Catheter (urine): A straw that is used to collect pee from the bladder
Comfort Positioning: Different ways to hold your child that provide security and comfort and help with procedures and exams
Intranasal: Within the nose (medication can be given through the nose to provide fast relief)
IV: Little straw that is placed in the vein (blue lines) that can be used to get blood for tests and used to administer medication
Numb: an area that is temporarily asleep and has no sensation
NPO: Nothing to eat or drink
Otoscope: tool used to look inside the ear
Pain Scale: Rating system used to determine your child’s level of pain
PCP: Primary Care Physician (your child’s regular doctor)
Splint: A hard board that is used to hold a broken bone in place to keep it still
Sterile: Medical supplies that are 100% clean, germ, and infection free (cannot be touched our used without sterile gloves)
Sutures: Also known as stitches- used to repair a cut (little bow-ties)
Triage: Area where your child is assessed to determine their medical needs
Vitals: Temperature, blood pressure, heat rate, respiratory rate, and oxygen levels 

People in the ED:

Attending Physician: A doctor trained in pediatric emergency medicine that is responsible for your child’s care and directs the health care team
Chaplain: Provides spiritual care, counseling, emotional support, prayer and comfort
Charge Nurse: Lead nurse in charge of supervising ED staff and making daily decisions
Child Life: Trained and educated to help children overcome their fears, provide preparation, support, teaching, and comfort
EDT: Paramedic or Emergency Medical Technicians specially trained to work in our ED to perform procedures, assessments, and provide medical care
Fellow: A doctor who has completed their residency and is training specifically in pediatric emergency medicine
Nurse: Specially trained to work with pediatric patients to provide emergency medical care
Registration: Collects your personal information so it can be properly recorded
Resident: A doctor who is receiving further training in pediatrics or emergency medicine
Social Work: Trained and educated to care for the social and emotional needs of families
Volunteers: offer their time to serve patients and families and make the visit easier

Keep checking for additional posts about the emergency department!

by Amanda Meyer
Child Life Specialist

Because kids are kids, you may find yourself needing to make a quick trip to the emergency department. There are many reasons a trip to the ED may be necessary including the time of day, the severity of the injury/illness, a referral from your pediatrician, or simply accompanying a friend. I recently started training in the ED and have quickly learned the swift pace that comes with the environment. I thought it might be helpful to share some tips for families should you ever find yourselves in an emergency department.

When most people think of the ED, they picture screaming children with horrible injuries all rushing through the door. Yes, some interesting things come through the door and children do cry, but the process is quite organized and efficient. The goal is to get your child assessed, “fixed”, and back home as quickly as possible. The same family-centered care policies used in the hospital are also implemented in the ED. 

Children may arrive to the ED by ambulance, helicopter, or walk-in. With walk-in visits, families may have a better chance to “prepare” before arriving. If you have time to pack a bag here are some suggested items to make the visit easier, but don’t worry, most of these items can be provided if you forget something. 

• Comfort items (blankets, pacifier/bottle, stuffed animal)
• Play items (toys, books, music)
• Change of clothes
• Phone and wallet
• Documentation (insurance cards, phone numbers, ID)
• Person of support (for you and your child)
• Medication/Equipment  (It is important to bring, or know, any medication or medical equipment your child uses or has used recently, even if it isn’t working properly)

***Important Note: Try to avoid your child eating or drinking right before coming to the ED and try to remember the last time your child had anything to eat or drink, some medications and procedures require your child to have an empty stomach***

When you arrive to the ED, you will be assessed by the welcome desk nurse who will determine if your child needs Emergency Department or Fast Track (urgent care) services. You will be given a pager and sent to the waiting room. When the pager goes off, you and your child will be taken to the triage area. Height, temperature, weight, blood pressure and other common information will be collected. You will again return to the waiting room until a room and nurse become available. Your wait time may vary depending on your child’s level of need and the flow of the ED. Trust that the staff will appropriately and efficiently care for your child. Here are some basic necessities offered to families:

• Bathrooms
• Family Room
• Phones
• Televisions
• Volunteers (can provide activities and support)
• Vending Machines (remember to check before eating/drinking)
• Child Life, Social Work, Chaplain

While waiting, try to engage your child in an activity to promote distraction from the environment and reduce anxiety. The more calm and in control you are, the more relaxed your child will be. Remind your child that the ED/hospital is a safe place where lots of kids come to feel better.

Keep checking for additional posts about the emergency department!

Editor's Note: Every March is Child Life Month, which is a wonderful spotlight for awareness on the field of Child Life. As part of our celebration, More Than Medicine will "spotlight" child life specialists from various areas of Le Bonheur Children's. Today's post marks our first with a look at our wonderful outpatient child life specialist.

By Jamie Droke
Child Life Specialist

In honor of National Child Life Month (March), we are continuing to explore the many different areas of the hospital our department covers. Last week we talked about how it is helpful and good to know that we cover so many different areas. Child life looks very different depending on the area in which you cover and this is especially true in our outpatient areas. This week, we will highlight our various outpatient specialists.

Child life specialists cover in four of our outpatient areas including the Emergency Department (ED), Outpatient Clinics, Same Day Surgery, and Radiology. The specialists in these areas take special care to cover their departments at the most busy times. Specialists in the Emergency Department cover all seven days of the week, working in the afternoon and night hours in order to be present during the most busy times in the ED. The specialist in Same Day Surgery arrives early enough to prepare and accompany (if needed) the earliest surgical cases each weekday. Although each area that is covered is vastly different, there are some common areas of expertise between the outpatient specialists. These specialists all help patients and families cope with the stress and anxiety of the hospital. They utilize age appropriate teaching and medical play to increase coping and compliance with procedures, tests, and treatments performed in the outpatient areas. These specialists spend a lot of their time providing

• Preparation for procedures/tests
• Distraction and relaxation
• Emotional support
• Pain management
• Pre-operative preparation
• Positioning for comfort
• New diagnosis teaching
• Compliance support
• Medical play
• Bereavement support

As you will see next week, this list is slightly different than the list for specialists in critical care. And of course, this list is not all-inclusive. The different areas have special needs that specialists assist with on a daily basis. The best news is that if you have to visit any of these four areas, you are likely to encounter someone from our team. Next week we will spotlight the specialists who cover the critical care areas. In the meantime, Happy Child Life Month!!!

by Thomas Hobson
Child Life Director

The day has finally arrived and Le Bonheur Children’s begun the patient move.  We can even mark do to the minute when the move started. So, for those of you that are keeping score, on Friday, December 03, 2010 at 5:00 a.m. the move began.

The major change was the Emergency Department.  The (now) old ED closed at 4:59 a.m., and the new one opened up at 5:00 a.m.  Now, I’m probably being a little too broad in saying the old ED closed.  In fact, it continued to run until all the patients were discharged or admitted to the hospital.  So for a while, we were running two EDs.  (Which is so confusing that even my AutoCorrect keeps trying to keep me from writing it.)

There has been a real excitement in opening the new emergency department.  When the first ambulance arrived, Memphis Fire EMT Mark Sykes and Paramedic Derrick Delancy brought four-month-old Justin Fisk who had RSV. Justin and mother Kimerie Tate were greeted with balloons and cheers.  Obviously, it’s a rare occasion to cheer when someone comes to the ED.

In a bittersweet situation, the first people to walk through the lobby of the ED were Tiffany Casey and her five-year-old son Shane Casey who was coughing, vomiting and shaking. Tiffany serves on the Family Partners Council, and she helped design the new hospital for patients and families. 

It is a truly amazing feat that was done this morning.  The Le Bonheur Children’s team pulled together to seamlessly transition from one emergency department to another one.  If you’ve never had to transition into a new ED before (because, who hasn’t had to do that), trust me when I say that it’s a lot of work and planning. I can also attest for the excitement in the Emergency Department, as I heard various cheers and celebrations as a lifetime’s worth of firsts were happening.

In all of my years at Le Bonheur, this is quit possibly one of my proudest moments.  Between the infectious excitement of the staff, the wonderful new facilities, and the exceptional care provided, there is magic in the air. And as a parent, I feel safer knowing that Le Bonheur is here to serve not just my children, but all of the children.

So, if everything is this exciting now, I can only imagine what the next two days will be like!

by Thomas Hobson
Child Life Director

Let me start by saying that just because you work at a children’s hospital does not mean that you will never need the services. As a matter of fact, there are many Le Bonheur associates that have also been parents of patients.  I can know say that my family has joined those ranks with both of my children.

Late Saturday afternoon, my son and daughter had been playing around and my daughter fell about 2 ½ feet off of a bed and hit her head on a hard floor.  There wasn’t any blood, but instead a bump and lots of crying.  Everything was going great until she started vomiting.

A quick call to her pediatrician’s office, and we were told to watch her.  However, if she vomited again, we were to talk her to Le Bonheur’s Emergency Department.  Needless to say, on Saturday night, (after dropping my son off at a friend’s house) my wife, daughter, and I made our way to Le Bonheur’s Emergency Department.

Now, I know what you may be thinking, “this guy works for Le Bonheur. I mean they did trust him with a blog.  So, of course he’s going to get the red carpet.”  My family did receive great service, but most people we interacted with had no idea I was associated with Le Bonheur.”  How, you ask.  Simply put, I normally wear ties at work, and for some reason, I’m hard to spot in a t-shirt and shorts.  Also, I was serving that night in the role of a parent.

The Emergency Department was busy, but the physician, Dr. Pollack, and the rest of the staff did a great job caring for my daughter.  They made sure that she (and mom and dad) understood what was going on.  They made sure she was comfortable, even bringing her a warm blanket.  Trust me, it wasn’t cold, but she does loved blankets.

When she had to have a CT Scan (or a “cat vision” as she later told her brother), Angie, the radiology technician, took the time to teach her about the scan.  My daughter was obviously nervous, and the extra time of letting her stuffed pig experience it first made all of the difference.  Now, as I write this from both a parent and child life specialist perspective, it makes me proud to know that professionals like Angie here at Le Bonheur.

So, why am I telling you about this?  Because I, like the rest of Le Bonheur Children’s staff, love this hospital. It’s rare that I’m on the other side of care.  I am amazed and proud of the experience, and grateful for the care we were given.  I trust in this hospital so much that I would bring my own child here.

Fortunately, it turns out that she’s fine.  Personally, I think she inherited a hard head from her father…

by Thomas Hobson
Child Life Director

Since we are incredibly close to the opening of the new hospital and Crystal’s post on Tuesday, I thought I would share a sneak preview of the Emergency Department (ED) in the new hospital.  This is an area that might be the only part of the hospital a family ever interacts.  It seems important to share a little bit about all of the changes.

Often, people will call it an emergency room, but let me assure you that there are way more than one room.  As a matter of fact, the new ED will have 60 exam rooms, which is an increase form the 39 in the current facility.  Even more exciting is that the new space will be approximately 50 percent larger than the current space.  There are some rooms dedicated to specific treatments, including 9 respiratory rooms, 3 orthopedics rooms, and 4 trauma beds.  Additionally, there will be 5 triage rooms, which will help to treat patients in a more efficient manner.

The ED see approximately 70,000 children each year, and treats more than 13,000 major and minor traumas. Since there is such a high need, there will always be 5 attending physicians, 1-2 fellows, and 5-6 residents.  This level of physician staffing will be able to provide the high level of care and expertise patients and families expect when coming to Le Bonheur Children’s.

If you have been watching the construction of the new hospital, you may have noticed that the helicopter-landing pad is located at the top of the building.  If a patient is transported via helicopter, there is a dedicated elevator.  What’s more impressive is that it can deliver a patient to the ED in one minute!  The elevator will only access the Intensive Care Unit, the Surgery Suites, and the ED.

In previous posts, I have mention that artwork will play a big roll in the new hospital.  The ED is the home for the some of the winning pieces from a recent art contest Le Bonheur held for children in the Mid-South.  The contest received over 3,000 submissions and the art committee selected 200 pieces.  The artwork will be featured along a long hallway that runs between the ED and radiology department, and will have an aquatic theme.

All of these different elements come together to make the new Emergency Department, and we couldn’t be more excited.  No one comes to an ED thinking that it will be a fun experience.  Le Bonheur Children’s has developed a plan of care, and the space to support it, to make the most out of the situation. 

Hopefully, you will never have to bring a patient to the ED.  However, if you do, know that we’re here for you.

Yesterday, I talked about the importance of the triage process, and how a decision is made to determine the degree of treatment need for your child.  If the decision is made that a lessened degree of treatment is needed, you will be assigned to the Le Bonheur Children’s ED Fast Track.

If you are not sent to the ED Fast Track, don’t worry.  Despite what the name may imply, it actually makes visits to the Le Bonheur Children’s Emergency Department faster for everyone.  If a patient is kept in the main emergency department it is because of the need for that level of care.  The ED Fast Track is a little bit closer to a minor medical center.

So, once you check-in with the triage nurse, they will give you a “blue pager.” This circular pager will appear similar to those that you might get at a restaurant on a busy night.  However, this pager will help you more than you realize.  During the wait time, we know that people get nervous about even getting up to go to the bathroom for fear that they will miss their name being called.  There isn’t need to worry about being called.

Once you are sent over to the Fast Track area, you will check-in with their team at the window.  They will give you another set of paperwork to be completed.  At this point, you’re still going to hold on to the pager.  Once you’ve completed the paperwork, you will turn it back in at the window (and still hold to the pager).

Now comes the fun part, you get to wait for the pager to go off.  The great news is that this group works tremendously efficiently, and will do everything in their power to treat you in our child as quickly as possible.  Once your pager lights up and vibrates you and your child will go to the window, give the staff the pager, and they’ll take you to a room to be treated.

So, in a few short paragraphs, that is the Le Bonheur Children’s Emergency Department Fast Track.  Also, if you've been to Le Bonheur Children's ED before, you may have heard of the Fast Track referred to by other names (examples of previous names have been Non-Acute Care and Zone 8).

Recently, I asked some of our readers what we needed to write about. We received several suggestions, and the one that was selected impacts lots of families: The Emergency Department. More importantly is what do parents need to know when coming to Le Bonheur Children’s Emergency Department.

Hopefully you will never need to our Emergency department, but when you do need it, we want you to know the important stuff. In 2009, Le Bonheur Children’s Emergency Department (or ED) treated more than 75,000 patients. As you can imagine, that’s lots of families, and unfortunately, when you need the services of the ED, you don't have time to research "what to do".

We have had families that have spent more time than they care to think about in the Le Bonheur Children's ED, and they have learned some tricks and tips. Our ED staff is another great resource, but how often do families have the time to ask them "specific" questions. Our thought was "why not talk to both groups and see what they have to share." In response, I started working on a Parent’s Primer: The Emergency Department.

I’ve been on a journey of talking with staff, asking parents for advice, and finding all of the answers that you might need to know when you come into Le Bonheur Children’s ED. This week, we’ll be sharing our findings. So, first things first: checking in.

However, there are lots of other areas, tips, and tricks to know about a visit to the Emergency Department. I’ll keep discussing those, and if you have questions or questions leave them, and I’ll try my best to answer them.