Hi, this is Mark Raven. Welcome to episode 52 of lean
blog audio. This is a post from May 18th
2015, and it's titled with the question.
Us hospitals have the best ER care for kids, but aren't
prepared for them. There's been a back-and-forth of
views about the state of pediatric emergency medicine.
Recently in the Wall Street Journal, let me start actually
first with the more recent statement rebuttal from dr.
Mike Michael Girardi, president of the American College of
emergency physicians in the form of a letter to the editor, he
wrote quote, emergency care of children in the u.s. is the best
in the world. Emergency physicians treat more
than 22 million sick and injured children under age 15 each year
and the vast majority of them have good outcomes.
If a child has a medical emergency parents should get
that child to the nearest emergency room and have
confidence that they are receiving top quality Care in
the right place. from the right Physicians end of quote, It's
the quote, the best in the world, says the doctor is that
an opinion? Where is the data to back that
up? You know, is quote, the nearest
emergency room. Always the right choice.
I think that's a great question for an adult.
Patient to ask is, well, what does a vast majority mean?
Is that 80%, you know what is a quote unquote?
Good outcome. It's easy for the doctor to tell
people. They should have confidence, but
then again. It's easy to say things like,
you know patient. Safety is always our top
priority as I've blogged about before.
So if you want to see a link to a post on that or the letter or
the Wall Street Journal article, I'm referencing go to lean blog
dot org, slash audio 52 when you can.
So what did the original Wall Street Journal articles say
about the state of preparedness and Hospital LEDs?
You know the headline is a bit, damning it says many Hospital ER
s aren't ready to treat children Aldrin sub headline reads.
Hospitals, aim to be prepared, many lack equipment, and
pediatric training for doctors and nurses.
So, from the article, it says, when a child has a medical
emergency, the first instinct is to rush to the nearest hospital.
ER, but many emergency rooms are ill equipped to treat infants
and children. And they are staffed with
doctors and nurses, who may not be trained in the specifics of
pediatric care and of quote, So what did the data suggest, you
know, says 30 million American children, end up in the Ed for
care. 90% of those go to General non pediatric hospitals, again
from the article. Quote, the ER staff often lack
necessary, Emergency Equipment, such as needles, catheters
breathing, tubes and instruments designed and sized for different
age. Children's unique Anatomy.
They may also lack a plan to deal with children in a mass
casualty incident or natural disaster, and of Well, it says
also in the article, the mean Readiness score was 69 on a
scale of 100 up from 55 in 2003. Now, the Readiness survey is
based on American College of Emergency Physicians guidelines
which dr. Girardi, the author of The
Letter should be aware of, so they're making progress.
But really what what's the meaning?
What's the context? What's the patient impact of
having a 69 writing a score instead of a 90, or 85 or a 100?
I wish dr. Girardi had addressed what the
gaps are and what they're doing about it.
Instead of making us weak being statement that says, basically,
hey, everything is okay. Toyota says, no problems is a
problem. I'm not sure if dr.
Girardi, subscribe to that view, maybe he says, the data says,
things are getting better or are they again from the article
quote? However, the authors of the
study caution that the review likely Mated hospitals Readiness
because there was no way to verify what hospitals reported
about their status and quote. That's the problem with
self-reporting. They might not want to admit
that there's as much of a problem as there is, for
example, from the article, more than 15% are missing critical
tools, such as special for steps to remove objects obstructing, a
child's Airway and another statement of the problem and
this is a quote from Alfred such etty chairman and Of the New
Jersey, Emergency Medical Services for children advisory
Council and the chairman of an emergency department.
He says, parents are going to stop at the closest building
with a big red emergency sign that may not be the one that's
going to fix the lacerated spleen, but they should be able
to manage an airway, get an IV in and get the child
expeditiously to the place with the expertise and of quote that
seems like good advice instead of assuming or trusting or being
confident that all hospitals are.
We good dr. Craig advises parents to ask
their family doctor which hospital ER in their area is
better prepared for children. Now, you know, if the question I
would ask if their family doctor knows well that be based on
opinion or facts, So, you know, process problems can harm
patients. And one way that this lack of
preparedness, alleged lack of preparedness.
The doctor might say, because again, everything is fine.
That lack of preparedness can hurt.
Young patients one way is the lack of standardized work around
expressing patient. Weights in pounds or kilograms
again from the journal. It says, one area of concern.
When treating children one-third of hospitals, don't follow
recommendations to record. 18 kg rather than pounds medication.
Doses are based on weight in kilograms and Mix-Ups are a
leading cause of medication errors says, Maryann gauche
Hill. Who led the Readiness study in
as chief of the division, of pediatric emergency medicine at
Harbor UCLA. Medical Center in Los Angeles.
One kilogram is equal to 2 point 2 pounds.
So if a 30-pound child, with a broken leg is mistakenly given
morphine for pain, based on a way to 30 kg that is Sickly a
double dose which could make you stop breathing.
Dr. Hill says, now does your family physician know which
hospitals do follow or? Don't follow that basic
guideline when we can admit that there's opportunity for
improvement or as one doctor quoted.
In the article, says, or we can just pretend things are fine or
scream of quote, yellow journalism is one Wall Street
Journal, comment? Or did he wrote he or she wrote
headline? Is baloney and Acts of yellow
journalism, not supported by the facts and not even by the
content of the article. Now calling something bologna,
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