Wintertime in the Texas Children’s emergency center

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During this time of year (usually September through March), “wintertime” illnesses, such as the common cold, croup, bronchiolitis, asthma exacerbations and flu-like illnesses usually inundate most emergency centers (ECs), urgent care clinics and primary care offices. With significantly higher patient volumes, sicker patients and maximized hospital beds, this “perfect storm” oftentimes leads to crowded waiting rooms, long EC wait times, delayed admissions, and parental and patient exhaustion and frustration. In an effort to prepare patient families for future EC visits during this very busy time, I thought I would share some frequently asked parental questions and concerns:

What should I bring to the EC? 

Unless you go to a hospital where your child’s medical information is readily available (i.e., all Texas Children’s locations including our three hospital campuses, Texas Children’s Urgent Care clinics and Texas Children’s Pediatrics locations all use the same electronic medical record system), many EC physicians cannot access your child’s medical record. So, when going to the EC, it’s very important to bring a copy of your child’s:

• Medical information (with past and current medical issues/diagnoses and surgical procedures)
• Vaccination records
• Medication and food allergies
• Current medications (both prescription and non-prescription)

Additionally, because it’s difficult to predict how long your child may wait before seeing a physician or medical provider, you may want to bring some toys/activities, comfort articles and snacks for you and your child/children. 

How do you determine the next patient in line? 

Unlike typical waiting lines, where a “first-come, first-serve” process is standard, the order with which EC patients are seen and treated is determined by a triage system designed to rapidly identify and prioritize patients based on the severity of their illness or injury and their need for emergent therapy.  By using key information, such as a patient’s age, signs and symptoms, past medical and surgical history, physical examination, and vital signs (which may include heart rate, blood pressure, breathing rate, oxygen level and pain score), the triage system helps to determine the order and priority of emergency treatment.

How long will the wait be and why is it so long?

EC wait times are extremely fluctuant and are constantly changing. Because a patient’s wait time is not only determined by his/her own triage level, but also the triage level of all other patients in the EC, wait times can increase or decrease without significant warning. Although EC staff may attempt to give an accurate wait time, those numbers are usually best estimates; especially since many EC patients arrive not only through the front doors, but also by ambulances/911 calls and outside hospital transfers.

My pediatrician (or subspecialist) called us in, so why aren’t we seen first? 

When your child’s pediatrician or subspecialist calls Texas Children’s EC, communication regarding your child’s medical history, current illness/injury, and recommended evaluation/treatment plans will be relayed to one of the EC physicians. Currently, because all EC patients need to go through a registration process and triage evaluation, the phone call made by the referring physician does not guarantee/hold your child’s place in line. Your child’s triage level, as determined by one of our highly-skilled triage nurses, will determine his/her place in line. It’s important to remember that triage is a dynamic process! Although a patient may be assigned a lower triage level upon arrival, if his/her symptoms or vital signs worsen over the course of their EC visit, the patient will be reassessed and reassigned a new triage level.

Does my child need blood work? What about X-rays? 

After an EC physician has examined your child, they will determine whether your child needs further evaluation with lab work (i.e., strep test, blood work, urine testing) or radiographic imaging (i.e., X-ray, ultrasound, CT). Luckily, many pediatric illnesses and injuries can be diagnosed with a comprehensive history and physical examination, and unless there is a specific question that can be answered by a particular lab test or image, most physicians try and avoid unnecessary, and potentially painful, procedures and radiation exposure. If you still feel uncertain as to why your child may or may not be undergoing further testing, please let your nurse or physician know of your questions and concerns. 

What do I do if my child gets sicker? 

If you feel your child is getting sicker, particularly if he/she has lethargy (decreased responsiveness/hard to wake up), confusion, slurred speech, neck stiffness and fever, difficulty breathing, persistent vomiting and unable to drink any fluids, prolonged seizure activity, severe pain not controlled with over-the-counter medications, or heavy and persistent bleeding that can’t be stopped, you should immediately return to the EC or call 911.

We know EC visits are oftentimes unexpected, stressful, exhausting and time-consuming. Even though these winter months will inevitably bring higher patient volumes and sicker patients, the faculty and staff at Texas Children’s ECs are committed to providing a seamless, high-quality, patient-centered experience for all of our patients. Please feel free to let us know of any questions or concerns you may have during your child’s EC visit.