Just being a kid is tough enough. But being a child and having to visit the emergency room can be even tougher.
Children waiting in the ER--often brought in because their pediatrician's office had already closed for the day--may encounter adult victims of serious trauma, or county or state prisoners being brought in for medical care. And with little more to pass the time than a ceiling mounted television tuned to CNN and a few dog-eared magazines, the wait can prove excruciating for both children and their parents.
Such was the case at Prince William Hospital in Manassas, Va. With an average wait of up to 21/2 hours for pediatric cases in the ER, young patients had plenty of opportunities to be exposed to unpleasantness. The problem was borne out in patient focus groups, where 44% of those children and parents queried were less than satisfied with the experience of getting children treated in the ER.
The grumbling was a big concern for Prince William. Located in the burgeoning suburbs 30 miles west of Washington, the hospital serves a population that consists primarily of young middle- to upper-middle-class families. Nearly a quarter of the population is younger than 18, and pediatric services is a major service line for the hospital.
"We thought it would be better to see children in a separate area, and not mix with the adult trauma victims," says Sandi Verbin, M.D., a hospital pediatrician.
After just six weeks of planning, a supplemental emergency room called "ERjr" was opened in May 1999 in the occupational health center adjoining the main ER. It contains four examination rooms and a central nursing station. The children's ER is open from 6 p.m. to 1 a.m. on weekdays and 1 p.m. to 1 a.m. on weekends. ERjr accommodates children with moderate ailments. Children with serious trauma, respiratory arrest or other life-threatening problems are still treated in the regular ER.
Health plans bill ERjr visits as they would a regular ER encounter, says Nancy Littlefield, Prince William's vice-president of nursing.
ERjr represents a complete break from the typical emergency room. The waiting area is much smaller than the conventional ER, has kid-friendly decor and is furnished with scaled-down chairs and other furniture. A wide variety of games and toys--such as Legos, puzzles and Nintendo Game Boys--are available for the children to occupy the time, or they can watch TV or videotapes. They can even scrawl on the walls with a special removable paint.
Start-up costs were minimal: Because the occupational health center was already equipped and configured, there were no costs for additional rooms or equipment. The hospital spent about $30,000 on marketing. Since patients still come through the main ER for referral to ERjr, nothing was spent on outdoor signs.
Littlefield said the goal of ERjr was to cut an hour off the typical wait for treatment. Instead, the average wait was cut by nearly 90 minutes to an average of 67 minutes within the first six months of the department's opening. Redirecting the pediatric traffic also cut down the wait in the regular ER by as much as 90 minutes, to about two hours from 31/2 hours.
The community quickly warmed to ERjr. In its first full month of operation, it treated 307 patients, or about 10 per day. As of September it treated 581 patients, a near-doubling of traffic in little more than a year.
More importantly, nearly 100% of patients now say they were satisfied with the care their children received, nearly double the level before the project.
Not only has ERjr proven to be convenient, but it is also reaping medical benefits as well. "The kids are much more relaxed because they're in a less-threatening environment. They don't see people hooked up to IVs, and they have a playroom," Verbin says. She adds that a less emotionally frayed child can be easier to diagnose. "A lot of our job is separating anxiety from illness," Verbin says.