From emergency department to hospitalization

Perhaps nothing in life is as stressful as having a child who is sick or injured. Every year, there are approximately 14,500 visits to the pediatric emergency department (ED) at Duke, and of these, over 1,700 require admission or overnight observation.

Donald T. Ellis II, MD, of Duke Pediatrics' Division of Hospital and Emergency Medicine, wrote this article in the hope that, by removing a portion of the unknown component, the hospitalization will be more comfortable for both you and your child.

-- Dennis Clements MD, PhD, MPH

Donald T. Ellis II, MDWhen a child is admitted to the hospital through the emergency department, it is quite common for a parent or other caregiver to feel overwhelmed. They have most likely told the story or “history” to the triage nurses, the ED nurses, the resident physician (and sometimes a student as well), the attending, or supervising, doctor, and occasionally one or more consulting physicians.

If needed, the child may have had blood drawn, an intravenous line (IV) placed, x-rays or other imaging studies performed, and medications given.

Often, these events require several hours for completion. When it seems as if there is nothing more to do than be transported upstairs, there is actually a great deal to accomplish to ensure a smooth transition.

Starting the Process

After the physicians determine that a child needs to be hospitalized, a request will be submitted to bed control, the hospital personnel overseeing inpatient beds. This assures that there is not only a bed space, but also available staffing to care for the patient upstairs.

Concurrently, the admitting team is notified, and although the majority of pediatric patients are admitted to general pediatrics, there are hundreds of patients every year who are admitted to a surgical or medical specialty service (for example, neurosurgery, critical care, or cardiology).

For patients under the care of the general pediatric team, the ED physicians will contact the inpatient physicians to discuss the case. By having a direct conversation, they can communicate not only the history, physical exam findings, and the results of any diagnostic tests, but they can also ensure that the inpatient team has a good understanding of what the other diagnostic possibilities are at that time.

Occasionally, the admitting team asks for additional testing before the patient is transported, and the ED staff tries to accommodate these requests as much as possible.

In the Hospital 

Once a bed space is assigned for the child, the ED nurse will call “report” to the nursing staff on the pediatric ward. This allows the entire health care team the opportunity to become familiar with your child’s case.

Taking report, however, does not take the place of hearing the information firsthand. Therefore, staff will likely want the opportunity to review the history with you after your child’s arrival on the inpatient ward. By this series of checks and double-checks, the entire health care team can familiarize itself with the details that make your child’s condition unique.

When all of the preparations are complete, a staff member will escort you and your child from the emergency department. At times, it is necessary to be accompanied by several personnel and monitoring equipment. Usually, you will use a special elevator reserved for patients and staff to either the fifth or seventh floor of the hospital.

The staff will go with you to your assigned room. Although all pediatric rooms with the exceptions of the intensive care and step-down units are designed as single-patient quarters, in most cases, you are welcome to stay in the pediatric ward with your child as long as he or she is hospitalized. In fact, we would love it if you would! Parents and guardians can provide significant comfort to children, regardless of age.

While nothing will ever negate all of the emotional and physical stress of having a child in the hospital, our goal is for every child to receive world-class medical care. Hopefully, this description of the process of being admitted from the emergency department to the pediatric ward decreases the potential anxiety of the unknown.

Clay Bordley, MD, MPH, and Kelly Anderson, RN, assisted  with this article.

-- Donald T. Ellis II, MD, is a hospital and emergency medicine specialist with the Duke Department of Pediatrics.

-- Dennis Clements, MD, PhD, is the chief of primary care pediatrics at Duke Children's Hospital.