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PED-EM-L  September 2001

PED-EM-L September 2001

Subject:

Re: 18-21 year olds

From:

Richard Aickin <[log in to unmask]>

Reply-To:

Richard Aickin <[log in to unmask]>

Date:

Tue, 11 Sep 2001 13:09:16 +1200

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (155 lines)

In New Zealand we use 0-15yrs as the paediatric age group, with an extension
to 18yrs for young people with chronic illness to allow for transition
between adult/paediatric services.
My view is that the adolescent age group is rather poorly served by both the
paediatric and adult services here.  I'm not sure if I'd been admitted at
the age of 17yrs whether I would have preferred to be on a ward surrounded
by 2 year olds or by 90yr olds.
Regards,
Richard

Dr Richard Aickin
Clinical Director
Children's Emergency Department
Starship Children's Hospital
Private Bag 92024
Auckland

email [log in to unmask]
Office Ph/fax (9) 375 4308
Office Ph/fax Ext 5208
Emergency Department (9) 307 4902
Mobile 021 884 636
Locator 93 4275


> -----Original Message-----
> From: Steven Doherty [SMTP:[log in to unmask]]
> Sent: Tuesday, September 11, 2001 11:29 AM
> To:   [log in to unmask]
> Subject:      Re: 18-21 year olds
>
> Hi Geoff,
>
> 18-21 is staggering!  In Australia all of these would be considered
> adults.
>
> I'm not sure that I can answer your question but the most sensible
> approach to this I have seen is that 17 and over are adults, 15 and under
> are kids.  16 year olds at school are kids and 16 year olds who work are
> adults.  There are of course always exceptions to this rule but to me it
> sounds pretty sensible.
>
> Cheers,
>
>
>
> Dr Steve Doherty
> Emergency Physician
> Tamworth Base Hospital
> (02) 6768 3316
>
> This message is intended for the addressee named and may contain
> confidential information. If you are not the intended recipient, please
> delete it and notify the sender. Views expressed in this message are those
> of the individual sender, and are not necessarily the views of New England
> Area Health Service.
>
> >>> Geoffrey Capraro <[log in to unmask]> 09/11/01 05:51am >>>
> Dear List Subscribers:
>
> Our pediatric emergency department is situated in a large teaching
> hospital, and sees a significant number of children aged 18-21.  For
> institutional reasons, we are seeing a great deal more recently.
>
> Our group is just curious to know- what upper age limit applies for
> your PED?
>
> Do different rules apply to different settings?
>
> What should the upper age limit be?
>
> Thanks,
>
> Geoff Capraro
> PEM Fellow Boston Medical Center
>
>
> ------------------ Reply Separator --------------------
> Originally From: Richard B Ismach <[log in to unmask]>
> Subject:  Re: NP's in ED
> Date: 09/08/2001 03:00pm
>
>
> Kate, et al -
>
> As I told you off-line, we use both Nurse Practitioners and
> Physician Assistants in our adult ED fast track.  We use NPs and PAs
> interchangeably, but in a few ways PAs are better:
>
>    * In Georgia, PAs can prescribe independently, but NPs cannot
>      (not a problem in most states).
>    * PAs usually have better procedural training (e.g., wound
>      repair) at graduation.  After a few years of practice, the
>      difference vanishes.
>    * PAs are trained to practice fairly independently, but to work
>      with and under a physician's direction.  Some NPs expect to
>      practice completely independently, without any interference
>      from a physician.  In an ED setting, a physician will certainly
>      be named in any lawsuit involving a non-physician provider.
>      Thus, EPs are sometimes more comfortable working with PAs than
>      with NPs.
>
> Despite these issues, we are happy with a mix of PAs and NPs in our
> fast track.
>
> Billing is as Zach outlined: both NPs and PAs can bill (at 85% of
> the physician's fee) for E&M or procedural services.  However, many
> private insurers, at least in Georgia, are now refusing to pay for
> PA or NP services in the ED.  It is well established that customers
> (patients) are better satisfied and costs are lower with
> non-physician providers.  Thus, this seems to be just a ploy to
> avoid paying some claims.  Still, this may be a major issue in some
> settings.
>
> The alternative is for the physician to bill for services of the PA
> or NP.  I am less familiar with this - all the departments I've
> worked in had the non-physician provider bill directly, using their
> own number.  This requires the physician to see each patient, a
> potential problem for everyone's efficiency.
>
> Some PA resources on the web:
>     http://www.aapa.org/
>     http://www.sempa.org./
>
> Rich
>
> --
> Richard B Ismach, MD, MPH
> Assistant Professor of Emergency Medicine
> Emory University School of Medicine
> Office: (404) 712-9656
> Pager:  (404) 686-5500 -> 11037
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
>
> *********************************************************************
> This message is intended for the addressee named and may
> contain confidential information. If you are not the intended
> recipient, please delete it and notify the sender. Views
> expressed in this message are those of the individual sender,
> and are not necessarily the views of NSW Health.
> *********************************************************************
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
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