One Size Does Not Fit All

That's the message of RBaby Foundation when it comes to Emergency Departments.

I had never heard of RBaby until a friend posted a link to this Petition on Facebook.  The purpose of the Petition is to improve Pediatric Emergency Care and to insure that EDs are capable of treating pediatric patients.  The story behind RBaby is heartbreaking and I am in awe of the strength of the parents who founded the organization.

If you've ever had to take your child to the ED and didn't have the luxury of a children's hospital (because with so few pediatric hospitals in the US, it truly is luxury) you might have realized early on that the parade of residents and attendings were often winging it when it came to diagnosing and treating your child.  Or, if you are not a frequent flyer in the pediatric medical world, you may have thought that surely this large hospital to which you had taken your child actually had ED doctors who had actual experience in diagnosing and treating children.  Sadly these beliefs may have been wrong.

When Eliza was discharged from the NICU one of the nurse practitioners told me in no uncertain terms that if I needed to take Eliza to the ED, there were certain hospitals I should take her to and ones I should not take her to.  She didn't say this because they "bad" hospitals, in fact they were very, very good, but because they did not have ED staff dedicated pediatrics.

Having spent some quality time in pediatric EDs I have also found that the quality of care depends upon which doctor is assigned to your child.  When Eliza has headed to the ER the first thing that the triage nurse asks if she has any medical issues or significant medical history.  My stock answer begins with "Eliza was born at 26 weeks, weighed a pound, was on a ventilator for 67 days and was in the NICU for 100 days."  I fill in more details, but these basic facts are the first listed on her chart.

During one ED trip, the resident came to see Eliza and asked me "I see your daughter was in the NICU, why was she there?"  So I look at him and say "she was born at 26 weeks, weighed a pound, was on a ventilator for 67 days and was in the NICU for 100 days," even though I know this is right in front of him.  His next question was "yes I see all of this but why was she in the NICU?"  So I rattle off the more detailed reasons for the NICU stay (RDS, BPD, NEC, sepsis to name a few) but he asks me the same thing again and even tells me that I am not answering his question.  Now I must say I did think this was a trick question, so I cautiously offered up that when a child has little to no lung function at birth and weighs a pound they tend to be in the NICU for a while.  When he asked it the third time, I asked to see another doctor, one who actually might know something about pediatrics, prematurity and what the hell a NICU is.  He was quite obstinate and not too pleased that I walked over to the desk and demanded to see an attending.  Luckily the attending seemed to grasp why Eliza was in the NICU and our visit proceeded smoothly (except for the constant stink-eye I got from the dimwitted resident).  Some residents are great, this one, not so much.

During another hospital visit another resident wanted to place an IV in Eliza.  I asked how often he had done this to a 14 pound one year old infant.  He insisted he had placed IVs in "dozens and dozens" of children.  I asked how many times he had put IVs in infants.  He repeated himself (maybe he was related to the resident from the prior visit) and I asked again how many infants.  Finally he admitted that Eliza would be his first infant and I must say, he did seem pretty enthusiastic at the chance.  I declined his offer and demanded that a pediatric nurse with infant experience, the IV team or a NICU nurse come down to place the IV.  A very nice NICU nurse did the honors and had the IV placed on the first try.  This also resulted in resident stink-eye.

On yet another occasion when Eliza was severely dehydrated, and the pediatric ED was a bit crowded, the resident asked if I was comfortable giving Eliza 5 mls of pedialyte by mouth since he didn't think he could get an IV in her and there would be a long wait for someone who could.  I give this one some points for honesty.  But really, you are going to advertise yourself as a pediatric ED with this level of inexperience and tell a parent to wing it with pedialyte for a couple of hours until they can get to you?

My point is that, as a parent, not only do you need to arm yourself with knowledge of which ED to take your child to (assuming you have this luxury of choice), but also put aside any concern about asking questions or offending a doctor by questioning his choices, asking if he's ever done a procedure before (no matter how innocuous looking) and asking for another doctor if your gut tells you the one in front of you is clueless about your child' symptoms or the appropriate treatment.

So now go sign the RBaby Petition.