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Not a children's hospital.

Discussion in 'Emergency Medicine' started by Faze2, May 10, 2007.

  1. Faze2

    Faze2 2+ Year Member

    Nov 15, 2006
    Jessica Biel's Closet
    I do not understand sometimes why people bring their children, especially infant children, to the ER where I work. Their is not one Pediatrician in this entire hospital. Not one. I understand that if you are right near the hospital and something happens to your child, you want to take them to the closest possible place, but we get people here that LITERALLY go right past CHOP with their infant children and come here. I don't get it.

    I also don't get why Medics bring children here too. They know we are not a childrens hospital. Why wouldn't they bring them to a childrens hospital? Philadelphia has quite a few of them. Good ones too. Is there a rule that medics have to follow about where they take patients? I really don't know, I am not trying to bust balls or anything.

    Obviously ER docs are qualified to treat children, but it seems like if you have the choice of a Pediatric ER doc, wouldn't you rather take your kid there?
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  3. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD Physician Partner Organization 10+ Year Member

    Nov 18, 2002
    SDN Partner
    Yea! And all patients with vaginal bleeding need to be seen by OB, not a frickin ER doc. Why don't the paramedics take them to the OB's office? And what's the deal with patients with ankle pain going to their primary care. Those guys should go directly to an orthopedist!

    (Perhaps CHOP can't take care of every kid with the sniffles in town?)
  4. bulgethetwine

    bulgethetwine Banned Banned 10+ Year Member

    Jan 4, 2005
    Nice patronizing response, but you're off base. I agree with the OP.

    And I especially liked your backward logic of suggesting that CHOP can't take every kid with sniffles. Those are EXACTLY the types of kids who should go to CHOP. The ONLY kids who should be taken to the adults-only are the truly critical who need to go to the closest hospital.

    Think of it the other way: You think if an adult with the "sniffles" or mild chest pain shows up at Children's they're going to treat him?


    Hey, you're right, EPs in general treat (quite admirably) the pediatric population, but if you're advocating bringing kids to adult only hospitals when a peds hospital is readily available, one with proper pediatric supplies, support, and specialty services, then I think you're operating under flawed logic (SNAFU?)
  5. Faze2

    Faze2 2+ Year Member

    Nov 15, 2006
    Jessica Biel's Closet
    No, not what I meant at all, and your analogy really doesn't work. The difference between children who are sick and the other examples you gave is that there is an OB-GYN and Ortho doc in the hospital at all times or at the least on call that can see patients in the ER, so taking someone to the ER for such problems is not the same as a sick child. There is no PEDS department/doctors in this hospital, and these peope know this. If you have a readily available source of pediatric care for your child, not taking them there to be seen seems like a poor decision to me.
  6. ERMudPhud

    ERMudPhud Back for a visit 10+ Year Member

    Feb 24, 2003
    My wife and I have a verbal agreement that if our kids ever need the ER they are going to the childrens hospital even though our insurance wants them to go elsewhere. At a childrens hospital everyone from the nurse to the phlebotomist to the CT tech are used to dealing with kids. That means everything from a better chance at less traumatic blood draws to a CT department more focused on minimzing doses and extraneous exposure.

    I work at three hospitals with three different systems. In one there is a seperate peds hospital within the hospital so I see virtually no kids except severe trauma. At another there are pediatricians and peds specialist in patient but I see all the Peds ER cases. The third has no peds services whatsoever so if you need anything beyond what I can do in the ER you are going to be transferred. Even phone consults are difficult. I am fine seeing kids in either of the first two settings but absolutely fear and hate it in the third. We also have no OB/NICU backup in that last hospital which really scares the S--T out of me.
  7. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD Physician Partner Organization 10+ Year Member

    Nov 18, 2002
    SDN Partner
    You have an orthopod in the hospital at all times but no pediatrician? That's a bit odd, but okay, it's your hospital.

    Assuming your patients know the inpatient pediatrics capabilities of your hospital is a big assumption.

    Many emergency physicians see a population that is 20-40% peds (I do.) I admit less than 5% of them. I consult a pediatrician on less than 10% of them. There is a pediatric hospital in the area and probably 8-10 other ERs. Assuming each of these hospitals sees 20% peds, if all these kids went to the peds hospital ED they would be 3 times as busy as they are. I know they don't have that kind of capacity. If everyone went there, how "readily available" do you think that care would become?

    Now, if you are in an "adult-only ER" that's a different story, but I've never seen one of those. Many EPs work in facilities that do not have inpatient peds services. Many work in facilities without inpatient cardiology services. If the patient needs more care than you provide, you transfer the patient. No big deal. If a parent would prefer their child not be transferred on the rare occasion they need to be admitted, then they should take their kid to the peds ER. Suggesting they are stupid for doing otherwise shows a lack of understanding of the issues involved.

    And MudPHud, if you took YOUR kid to the ER, I'm pretty confident he would need inpatient services, probably an ICU admission.

    I'm not saying Peds EDs don't do a lot of things better than a general ED (I think they do a better job on average at treating kids). My argument is that most kids don't need to be seen by a pediatric emergentologist nor a pediatrician and that there is not enough capacity in the pediatric emergency system to evaluate all kids with urgent needs.
  8. Wackie

    Wackie Inappropriate, always 5+ Year Member

    Mar 20, 2006
    Home with the Armadillo
    Consider the regular public opinion of a children's hospital. They think only cancer patients or really, really, really sick kids go there.

    As for EMS, I dunno. The children's hospital is literally just down the street. Yet, we'll get babies who fall off of second story balconies via EMS.
  9. docB

    docB Chronically painful Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    Nov 27, 2002
    Las Vegas, NV
    We only see the shallow end of the gene pool for peds because the parents literally have to walk past the giant, red, neon signs for the chindren's hospital down the block to bring their broods here. Then they just can't understand why the nurse had to stick the kids 3 times to get the IV and why they have to be transferred for admission. I agree with those who would only take their kids to a children's ED.
  10. flynnt

    flynnt Member 10+ Year Member

    Sep 24, 2001
    Maybe they (or somone they know) had a bad experience at CHOP. Maybe they heard the wait times are better at your facility. (I have heard people chose to go to another very nearby ED over HUP because of "shorter wait times". I imagine these same people might choose a "short wait time" over CHOP). Maybe it's easier to park at your ED. Maybe the mother-in-law recommended the children's hospital, so of course the mother will go anywere BUT a children's hospital.

    You can't count on parents to know whether or not there is a pediatrician in the hospital. Medics should. But again medics often have protocols indicating they go to the "nearest appropriate facility".
  11. DrQuinn

    DrQuinn My name is Neo Moderator Emeritus 10+ Year Member

    Dec 6, 2000
    Haha, ah, another DocB good quote....

    I am in an "adult-only" EM. We have Children's National Medical Center right next door. Part of our "medical complex." Same parking lot.

    But every once in a while a 8 or 9 year old will stroll in with their parents. Most of the time because teh wait over at children's is too long. A lot of our EM guys refuse to see peds (they've been doing adult only EM for 10+ years). I, as a new grad, will see them all, as I want to stay up on Peds, but believe-you-me, if it is an even remotely complx peds case, none of the specialty people will see them.

    I had a 16 year old who spilled hot liquid over his family jewels, 2nd degree burns. I called the trauma/burn people to come see him, they refuses, because he was too young. These are the same residents who rotate over at the pediatric burn service next door. But I understand, it has to do with their attending.... but.....

  12. tonem

    tonem Senior Member 10+ Year Member

    Sep 13, 1999
    I love it when they refuse to see the 6'2" 210 lb 17 year old...
  13. leviathan

    leviathan Drinking from the hydrant Physician Moderator Emeritus 10+ Year Member

    Sep 30, 2003
    Vancouver, BC, Canada
    But the giant red neon sign of an In-N-Out is much more appealing...
  14. Ouch...
  15. froggiepremed

    froggiepremed not "Pre" any more 2+ Year Member

    Apr 21, 2006
    Harrogate, TN
    I would agree, and anything important gets sent to the hospital next door.

    The most common reason/excuse to bring the kids over to the adult ED was because the line over there was too long - an excuse that may be acceptable if the problem is somewhat minor
  16. ERMudPhud

    ERMudPhud Back for a visit 10+ Year Member

    Feb 24, 2003
    So I was at work the other day, a few miles from a nationally known childrens hospital and get a 9 year old with N/V/D for a few days, dehydration, syncope, abd pain, chest pain. We have absolutely no pediatric services. no inpatient, no outpatient, no peds er, no specialists. In taking his history I discover he had some sort of congenital heart defect, and he's already had his appendix AND GALLBLADDER removed. Now I know I'm not dealing with a normal little kid. I get his records from the childrens hospital and discover he had the identical presentation there the year before with mild LFT problems and a grossly abnormal HIDA scan. He had a huge work up initiated and was supposed to follow up with peds GI but never did because they were "rude to him." Now he wants me to figure out what is wrong with him. Needless to say I checked a few labs, tanked him with fluids, and sent him sternly back their way.
  17. BadVB750

    BadVB750 Senior Member 10+ Year Member

    Apr 23, 2002
    It makes it really rewarding when pts like this are rude to you.

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