I was working in the pediatric ER the other night, and by the middle of the shift, I felt like jumping off the Verazzano Bridge. We had about 50 people waiting to be seen in the waiting room, with the average wait time about 6-8 hours. I am tempted to print this out and post it by the area where you sign in.
Feel free to add to this list!!
1) If your child has a fever, TREAT IT. Please dont let your baby have a 106 fever all day and not give them motrin or tylenol because "you want us to see that the child has a temp" or "my child doesnt like the taste of medicine". I doubt you or your child will like going into febrile seizures either. It wasnt the best idea for you to let your child have a fever for 3 WEEKS and then come in and expect to be seen RIGHT NOW.
2)If your child has a fever, dont keep them bundled up in a snow suit, 3 sweaters, wrapped in 2 blankets. I know the baby feels chilly, but they dont need to accumulate any more heat.
3) I know you know how much your baby weighs approximately, but we DO need to weigh the child again, and yes, we also need to weigh them without all the clothes/shoes on. Pediatric medications are based soley on weight, and we need an exact weight in kilograms order to not over/underdose them.
4) The order of being seen is based on patient acuity, not time of arrival. The child that checked in 2 minutes ago that can hardly breathe IS going to be seen before your child with the flu. Yes, we know your child is sick and that you have been waiting here for 6 hours, but the ER is not first come first serve. We need to see the sickest (and youngest in some cases first) The baby who is 6 weeks old who is sick cant wait, but the 2 year old probably can. We are trying our best to get you in and out as fast as we can.
5) Yes I know your pediatrician called ahead and they sent you here, but so did everyone elses. It seems that pediatricians these days are sending people to the ER for bloodwork/x-rays, ect that could wait to be done in SOME cases until you can get to the lab/radiology center the next day. If waiting to the next day is an option, do it. Chances are, you will be in the waiting room until the next day anyway before you are seen.
6) If your child has an earache or some other minor ailment, please bring them/call the pediatric office before you head to the ER. I promise you, if you bring your child to the ER for an ear infection or strep throat (unless instructed by your doctor or the child has an extensive medical history), you WILL be there all night waiting.
7) Yes, we do need to do a rectal temperature. I know your child doesnt like it, but we need the most accurate temp when the child has a fever in order to treat it.
8) If your pediatrician is sending you over, please ask for written instructions/orders. Parents tend to overdramatize the childs condition, and when I read the report/orders from the doctor they are usually much different from what the parent says. The parents will tell me that the child is in "severe respiratory distress" and the report says mild/moderate, and the child is sitting up, awake with an oxygen saturation of 100%. Besides, 9 times out of 10, the doctor will have given the child medication in the office and we need to know exactly what was given, how much and what time. Telling me that the child got "two breathing treatments and a steriod" doesnt help.
9) I know waiting in the waiting room is equal to a stay in hell, but I dont advise you to be going in and out. If they call you while you are out, they are going to think you left, and you probably wont be called again. If you really need to go outside to make a phone call ect, let the clerk know you will be right back.
10) I know you and your child dont like having an IV started or having blood drawn. Sometimes we need to do this. Dont start crying or freak out while we are doing this. Your reaction has a huge impact on how the child reacts. If you act like we are stabbing you in the neck, the child is not going to be calm either. Once the IV is in, please dont touch it. I know it sometimes hurts, but if you fiddle with it and it falls out of place than we need to do it all over again. If it looks "funny" or is causing pain, call the nurse/doctor and we will take a look at it and see if its OK.
11) If you gave your child any medications before you came in, please write down/remember what time you gave it, how much and what you gave them.
12) We know you have been waiting a long time, but we honestly cannot tell you when you will be seen. It could be 10 minutes, it could be 10 hours. Coming to the desk every 5 minutes asking, trying to choke the clerk, or trying to break the door down (this actually happened) is not going to get you seen any faster. In fact, it may buy you a visit from the police and/or child protective services.
The nurses at the Children's Hospital in San Diego are great! :balloons: The nurse gave me a sheet with the urgent care on it (our insurance didn't have the info. GRR). I hate the fact they couldn't have given it to me at the front triage area because it might have discouraged us from treatment or some crap. I wish they could give patients the info if it is more appropriate to go to an urgent care. Less wait, cheaper copay for me. I would have went in a heartbeat. At home the office is also open in the mornings on Saturday and Sunday for urgent/sick visits. And they have always told me to treat a fever. And I always assumed the nurse/dr at the ER (like when my youngest had pneumonia) would believe me if I said my baby had a fever but tylenol/motrin brought it down. Besides, ER visits aren't quick and your child's fever will probably rise while you are there. And since the nurses/drs at the ER (ours at least) don't like you medicating once you are there, you will have to check with the nurse, who will check the temp before okaying or giving tylenol and viola -- the can see your child has a fever.
canoehead, BSN, RN
6,909 Posts
I don't think anyone has said not to bring kids in for a fever that worries the parents; just try Tylenol first is all we ask. (and maybe give it again if it works... please?)