The Problem of Delayed care in Paediatric Emergency Rooms
Statistics indicate that children are among the heaviest users of emergency rooms. In America, for example, more than 800,000 children require care from the emergency department (ED) daily. These cases translate to more than 31 million cases of pediatric emergency cases annually in America alone (Barata et al., 2015). There are many concerns regarding the preparedness s of the ED to handle this influx of patients. It is easy to point out that delay in care is a real concern given the big number of patients and the lack of proper training or supervision of the emergency care providers (Barata et al., 2015). The implication is that the emergency departments face the risk of reporting a high number of pediatric deaths, majorly attributed to untimely care practices of professionals in the ED’s.
In a study that sought to analyze the trends in mortality of pediatric patients at a Chinese hospital, delay in care was found to be a factor that contributed to high fatality rates (Zhu et al., 2015). The study was conducted at a Chinese hospital between 2011 and 2013. The study documented a total of 466 919 cases which were reported to the pediatric emergency department. The study found out that the rates of death for boys admitted into emergency care were higher. The 230 deaths recorded during the period of the study were distributed at a boy to girl ratio of 1.4:1. The results indicated that the primary causes of pediatric deaths were cardiovascular, respiratory and neuromuscular conditions.
The most startling discovery, however, touched on the time that most of the deaths occurred. An analysis of the data revealed that 40% of the patients died 24 hours after admission into the ED. In addition, 45.2% of the pediatric patients died a few hours after arrival. The median for the time from admission to the time of death was 1.5 hours (Zhu et al., 2015). The implication was that delay experienced when the patients were brought to the pediatric emergency departments contributed to the high rates of death that occurred a few hours after patient admission. The researchers concluded that even though many a myriad of factors could explain these rates of mortality, delays were a major cause of the deaths (Zhu et al., 2015).
In a study that sought to establish the impact of crowding to the offering of timely emergency care, Barata et al. (2015) established that patients with acute medical conditions, whether children or adults were most affected. The study used a sample of 4 EDs to observe the trends in crowding and care provision. In the conventional setting, it is expected that patients with the highest acuity are given the priority in care in the ED. The researchers in this case, however established that these patients also experienced delayed care at times of crowding, meaning that their conditions were likely to get worse. The study established that the waiting room times for the severe patients in the ED increased to 35% during crowding periods (Barata et al., 2015). With this kind of delay, it was less likely that their health outcomes would be improved. Such findings apply in the case of both adults and children. The implication is that delay in the provision of care impacted not only the patients requiring minimal attention, but also the patients who had acute conditions.
In an exercise that sought to study the application of protocols in the pediatric emergency department of Postgraduate Medical Institute of Medical Education and Research (PGIMER) Bimal et al. (2009) established that application of appropriate protocol had the potential of improving the health outcomes for patients admitted to the pediatric emergency department. The study was informed by the realization that many of the deaths reported in the Indian hospital occurred within 24 hours of admission. The researchers realized that most of these deaths were preventable. The researchers attributed the deaths to the failure of ED personnel to swiftly identify the patients who need immediate care and offering the required treatment. To deal with the high rates of pediatric deaths, the researchers advocated for the use of a tool that would help in swift recognition and treatment of patients in the pediatric ED (Bimal et al., 2009). This study established that the emergency nurses were at the center of pediatric emergency care, and had the responsibility of combining professionalism and efficiency when dealing with emergency situations. The implication here is that such nurses needed to have enough knowledge and skill on how to effectively carry out the emergency care procedures (Bimal et al., 2009).
In an analysis of the pediatric deaths that occurred in the hospital, the researchers established that delayed case management resulted in the development of complications in the patients. All this was attributed to the lack of a nursing protocol to guide emergency nurses on how to handle pediatric emergencies. Once the researchers had developed a nursing protocol for handling pediatric emergencies, a survey was conducted on the patterns of the use of the protocol. The results of the survey indicated that the protocol was only used to manage only 39.3% of the pediatric emergency cases. However, the survey also indicated that half of the nurses in the pediatric ED viewed the protocol as very helpful in managing emergencies (Bimal et al., 2009). These results point to a gap of knowledge regarding the understanding the disparity between the number of nurses who view the emergency protocol as useful, and the number of nurses who actually apply the protocol in emergency pediatric care.
Triage nurses are among the most important health care providers that are involved in patient management in the emergency care provision. Triage nurses have the responsibility of pinpointing the patients who require the most immediate form of attention in the pediatric ED. Given the chaotic nature of EDs, the process of being effective in triage nursing can be challenging. In a study that targeted triage nurses in three Canadian pediatric emergency departments, Thomas et al. (2015) established that delays were a factor that contributed to the nature of health outcomes for emergency care patients. Pain management is central to the emergency care provided by triage nurses. According to the study, however, there are a variety of barriers that face the implementation of pain treatment protocols. The study made use of subjects that grouped into either General triage emergency department (GTED) nurses or pediatric-only triage emergency department (PTED). The two nurse categories had different approaches to the acceptable time taken to administer pain protocols. The common idea between the two groups, however, was the fact that delay was a factor that negatively impacted on the ability of patients to initiate pain protocols (Thomas et al., 2015). The results of the study pointed to the fact that different approaches to the emergency care provision were all impacted by the aspect of delay. The findings of the study build on the research that views delay and congestion in pediatric emergency departments as leading to negative outcomes for patients. Delays starts at the pain protocols applied by triage nurses, to the complex interventions that the patients require later.
An important aspect of pediatric emergency care is ensuring that the right treatment procedures are applied to the patients who require emergency care. The ED in most cases is characterized by chaos, with both the emergency health care providers and the families of the victims being stressed. In such situations, it is important for EDs to have clear communication lines that guide the relationship between staff and the patients. It is based on this understanding that Grahn, Olsson, & Mansson (2016) conducted a study to establish approaches to care that nurses who work with children employ in a pediatric emergency department. The goal of the study was to describe the methods that these nurses used in their interaction, while pinpointing the aspects that required further insight. According to the researchers, the responses from the seven nurses used in the survey indicated the need for more research being conducted on best practices in regards to pediatric emergency care provision. The researchers came up with three essential themes that guide best practice in emergency care. First is the ability of emergency nurses to initiate a healthy encounter with the pediatric patients. In addition, the nurses needed to be open to adaptations when dealing with the children. The third aspect that came up through the study was the need to establish family-oriented care for pediatric patients in emergency departments .
The researchers, in this case, concluded by noting that effective care provision in pediatric ED’s required the cooperation of the hospital staff and the patients of the patients. They argued that the breakdown of communication was central to the occurrence of delays in care provision. To deal with this problem, it was imperative for staff to be trained in effective means of communication with their patients. All this needed to be done in a timely manner to ensure that pain and discomfort are swiftly dealt with.
References
Barata, I., Brown, K., Fitzmaurice, L., Griffin, E., Snow, S., & Shook, J. (2015). "Best practices for improving flow and care of pediatric patients in the emergency department.". Pediatrics 135(1), e273-283.
Bimal, S., Kalia, R., Singhi, S., & Kaur, S. (2009). "Development of Nursing Management Protocol for Pediatric Emergencies.". Nursing and Midwifery Research 5(2), 101-106.
Grahn, M., Olsson, E., & Mansson, M. (2016). Interactions Between Children and Pediatric Nurses at the Emergency Department: A Swedish Interview Study. Journal of Pediatric Nursing 31(3), 284–292.
Thomas, D., Kircher, J., Plint, A., Fitzpatrick, E., Newton, A., & Rosychuk, R. (2015). "Pediatric pain management in the emergency department: the triage nurses’ perspective.". Journal of Emergency Nursing 41(5), 407-413.
Zhu, C.-p., Wu, X.-h., Liang, Y.-t., Ma, W.-c., & Ren, L. (2015). "The mortality of patients in a pediatric emergency department at a tertiary medical center in China: An observational study.". World journal of emergency medicine 6(3), 212.
