A Providence ER teaches how to keep a child's fever down, giving out simple kits to help The Emergency Department at Providence St. Vincent Medical Center in Cedar Mill is as predictable as the calendar: During cold winter nights and weekends, it is clogged with listless, feverish children and their exhausted parents.
While some children are ill enough to admit, staff send most with garden-variety ailments home, along with advice about keeping temperatures down.
But when fevers spike again, so do parents' fears. Families return a day or two later, the same sick child in tow.
The cycle can be draining -- and costly -- for everyone.
Last year, nurse Heidi Lindner and a group of colleagues worked to design pediatric "fever kits" after she read an article in a nursing publication about a Texas hospital that had used them.
FEVERISH?
In most children, normal body temperature is between 97.4 and 100.2 Fahrenheit (36.4 and 37.9 Celsius). Fevers can be brief, or come and go over a longer period. When a child has a fever, the body is telling the immune system to fight bacteria and viruses. Though fevers might help the body heal, treating one can help ease a child's discomfort.
The kits, which include a bottle of acetaminophen, a digital thermometer and a laminated dosing chart with instructions in English, Spanish, Russian and Vietnamese, reduced repeat hospital visits for fever.
In January, February and March, the hospital gave out 72 kits, said Marian Martin, nurse manager of the St. Vincent Emergency Department. Only three families returned.
In previous cold seasons, about half the patients had returned, Lindner said.
Martin said the kits, which are paid for with a small grant from Providence Health Plan, help empower parents.
"They may not have the experience or the resources to cope with a fever, or even buy the medicine," she said. "This does that."
And some parents are confused about how much medicine to give. "They'll say, 'I gave Tylenol this morning, but the fever is back.' They're afraid to overdo it, so they under-dose." The chart removes the guesswork, she said.
Indeed, a 2004 study in the journal of Pediatric Emergency Care showed that 12 percent of parents gave too much acetaminophen, while 41 percent gave too little. The authors concluded that proper dosing and timing could prevent most ER visits for fever.
The kits, which cost less than $3 to make, represented significant savings for the hospital, said Jean Marks, a St. Vincent spokeswoman.
"It gives tools to the parent and comfort to the child," she said. "And if the family doesn't have insurance, it helps us so we don't absorb the costs, either."
The idea for the kits originated in 2004 at the Presbyterian Hospital of Dallas, Texas, when nurse manager Mary Rowe wondered what the hospital could do to reduce "inappropriate return visits" for fever. The hospital defines such a visit as a return to the Emergency Department with upper respiratory infection or ear infection within 72 hours of initial treatment.
Many patients were inexperienced first-time parents or immigrant parents who lacked a support system, Rowe said.
"A lot of people are just here by themselves, without anyone who can tell them, 'This child is going to be OK,' " Rowe said.
"We certainly want them to come back if the child has a decrease in wet diapers (indicating dehydration), a seizure or is having trouble breathing," she said. "But a lot of folks were coming back when the child just had a minor fever or was fussy."
Within six months of launching the program, the hospital found an 80 percent drop in "inappropriate return visits" for fever. Between July and December 2004, Rowe said, the kits, which cost about $2.20 to make, saved the hospital about $55,000.
Locally, Providence is expanding its program to Providence Portland Medical Center, Marks said. "It's such a simple thing," she said, "and it can make such a big difference."
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