Don't we just hate to see these coming? We've been particularly plagued with
these since the novel H1N1 issue started.
We don't have any written policy for these type visits but we do deal with
them pretty consistently. Each patient is registered and triaged as an
intact group. If there's only one adult caregiver with the group, all the
kids get sent to the part of the ED (main/urgent side vs our
nonurgent/"rapid care" side) consistent with the needs of the child with the
highest acuity level. If one of the kids is emergent, all come back to the
room as soon as one is available and registration proceeds from there.
Depending on the current load in the ED, we might initially see only the
most urgent patient, with the others having to wait until things calm down a
bit. We'll usually try to assign two residents/midlevels plus an attending
if there are 4 or more patients and try to have at least one of the
residents/midlevels be the same one to see the most urgent child if one
exists. We can usually get along with one resident/midlevel and/or one
attending if there are fewer than 4 patients. On the urgent side we have one
room other than our trauma room that has 2 beds. We try to use this room for
"family plan" visits if it's available.
If there are two adult caregivers we often try to split the group up into
two rooms or even two sides of the ED if one or more of the patients is/are
of higher acuity. Those who go to the nonurgent side get in the nonurgent
queue and the ones assigned to the urgent side due to their higher acuity
get in the appropriate queue for the one with the highest triage category.
Again, we have no policy, but when complaints are similar or identical
(possible strep, possible flu) we don't necessarily do the indicated test on
every patient. For example, we recently had one patient brought in during
the day who tested positive for Flu A and was sent home. Mom then brought
her 3 other kids in the middle of the night to also be tested "because they
told me to bring them in for testing" (NOT!). All had flu-like illnesses and
no risk factors, so we didn't test any of them but sent them home (after
registration and exam) after telling mom they probably all had the flu. It
would have been nice to have done that at triage to save us time and the
family time and money, but we had obligations to fulfill... The most common
scenario in which we may skip testing is the one in which only one child is
checked in initially, although sibs come along for the ride. When the
initial child has a positive test, the mom frequently decides to check in
the other kids as well, whether they're sick or not. In that case we'll
apply the first child's test results to those with similar symptoms and
risks without testing them.
That's how we've done it during my 20 yrs at MCH. It seems to work for us.
Let's see how things shape up as the REAL flu season hits this fall!
Lou Romig MD
Miami Children's Hospital, Miami, FL
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: