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Hi, this is Mark Raven. 
Welcome to episode 52 of lean 

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blog audio. 
This is a post from May 18th 

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2015, and it's titled with the 
question. 

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Us hospitals have the best ER 
care for kids, but aren't 

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prepared for them. 
There's been a back-and-forth of

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views about the state of 
pediatric emergency medicine. 

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Recently in the Wall Street 
Journal, let me start actually 

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first with the more recent 
statement rebuttal from dr. 

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Mike Michael Girardi, president 
of the American College of 

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emergency physicians in the form
of a letter to the editor, he 

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wrote quote, emergency care of 
children in the u.s. is the best

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in the world. 
Emergency physicians treat more 

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than 22 million sick and injured
children under age 15 each year 

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and the vast majority of them 
have good outcomes. 

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If a child has a medical 
emergency parents should get 

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that child to the nearest 
emergency room and have 

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confidence that they are 
receiving top quality Care in 

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the right place. from the right 
Physicians end of quote, It's 

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the quote, the best in the 
world, says the doctor is that 

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an opinion? 
Where is the data to back that 

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up? 
You know, is quote, the nearest 

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emergency room. 
Always the right choice. 

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I think that's a great question 
for an adult. 

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Patient to ask is, well, what 
does a vast majority mean? 

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Is that 80%, you know what is a 
quote unquote? 

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Good outcome. 
It's easy for the doctor to tell

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people. 
They should have confidence, but

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then again. 
It's easy to say things like, 

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you know patient. 
Safety is always our top 

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priority as I've blogged about 
before. 

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So if you want to see a link to 
a post on that or the letter or 

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the Wall Street Journal article,
I'm referencing go to lean blog 

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dot org, slash audio 52 when you
can. 

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So what did the original Wall 
Street Journal articles say 

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about the state of preparedness 
and Hospital LEDs? 

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You know the headline is a bit, 
damning it says many Hospital ER

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s aren't ready to treat children
Aldrin sub headline reads. 

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Hospitals, aim to be prepared, 
many lack equipment, and 

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pediatric training for doctors 
and nurses. 

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So, from the article, it says, 
when a child has a medical 

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emergency, the first instinct is
to rush to the nearest hospital.

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ER, but many emergency rooms are
ill equipped to treat infants 

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and children. 
And they are staffed with 

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doctors and nurses, who may not 
be trained in the specifics of 

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pediatric care and of quote, So 
what did the data suggest, you 

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know, says 30 million American 
children, end up in the Ed for 

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care. 90% of those go to General
non pediatric hospitals, again 

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from the article. 
Quote, the ER staff often lack 

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necessary, Emergency Equipment, 
such as needles, catheters 

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breathing, tubes and instruments
designed and sized for different

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age. 
Children's unique Anatomy. 

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They may also lack a plan to 
deal with children in a mass 

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casualty incident or natural 
disaster, and of Well, it says 

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also in the article, the mean 
Readiness score was 69 on a 

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scale of 100 up from 55 in 2003.
Now, the Readiness survey is 

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based on American College of 
Emergency Physicians guidelines 

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which dr. 
Girardi, the author of The 

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Letter should be aware of, so 
they're making progress. 

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But really what what's the 
meaning? 

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What's the context? 
What's the patient impact of 

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having a 69 writing a score 
instead of a 90, or 85 or a 100?

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I wish dr. 
Girardi had addressed what the 

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gaps are and what they're doing 
about it. 

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Instead of making us weak being 
statement that says, basically, 

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hey, everything is okay. 
Toyota says, no problems is a 

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problem. 
I'm not sure if dr. 

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Girardi, subscribe to that view,
maybe he says, the data says, 

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things are getting better or are
they again from the article 

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quote? 
However, the authors of the 

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study caution that the review 
likely Mated hospitals Readiness

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because there was no way to 
verify what hospitals reported 

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about their status and quote. 
That's the problem with 

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self-reporting. 
They might not want to admit 

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that there's as much of a 
problem as there is, for 

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example, from the article, more 
than 15% are missing critical 

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tools, such as special for steps
to remove objects obstructing, a

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child's Airway and another 
statement of the problem and 

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this is a quote from Alfred such
etty chairman and Of the New 

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Jersey, Emergency Medical 
Services for children advisory 

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Council and the chairman of an 
emergency department. 

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He says, parents are going to 
stop at the closest building 

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with a big red emergency sign 
that may not be the one that's 

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going to fix the lacerated 
spleen, but they should be able 

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to manage an airway, get an IV 
in and get the child 

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expeditiously to the place with 
the expertise and of quote that 

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seems like good advice instead 
of assuming or trusting or being

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confident that all hospitals 
are. 

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We good dr. 
Craig advises parents to ask 

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their family doctor which 
hospital ER in their area is 

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better prepared for children. 
Now, you know, if the question I

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would ask if their family doctor
knows well that be based on 

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opinion or facts, So, you know, 
process problems can harm 

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patients. 
And one way that this lack of 

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preparedness, alleged lack of 
preparedness. 

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The doctor might say, because 
again, everything is fine. 

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That lack of preparedness can 
hurt. 

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Young patients one way is the 
lack of standardized work around

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expressing patient. 
Weights in pounds or kilograms 

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again from the journal. 
It says, one area of concern. 

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When treating children one-third
of hospitals, don't follow 

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recommendations to record. 18 kg
rather than pounds medication. 

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Doses are based on weight in 
kilograms and Mix-Ups are a 

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leading cause of medication 
errors says, Maryann gauche 

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Hill. 
Who led the Readiness study in 

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as chief of the division, of 
pediatric emergency medicine at 

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Harbor UCLA. 
Medical Center in Los Angeles. 

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One kilogram is equal to 2 point
2 pounds. 

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So if a 30-pound child, with a 
broken leg is mistakenly given 

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morphine for pain, based on a 
way to 30 kg that is Sickly a 

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double dose which could make you
stop breathing. 

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Dr. Hill says, now does your 
family physician know which 

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hospitals do follow or? 
Don't follow that basic 

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guideline when we can admit that
there's opportunity for 

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improvement or as one doctor 
quoted. 

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In the article, says, or we can 
just pretend things are fine or 

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scream of quote, yellow 
journalism is one Wall Street 

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Journal, comment? 
Or did he wrote he or she wrote 

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headline? 
Is baloney and Acts of yellow 

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journalism, not supported by the
facts and not even by the 

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content of the article. 
Now calling something bologna, 

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is that supported by facts, 
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