The idea is very noble, and something that in the right setting (i.e. Close enough physical locations, appropriate staffing, and "slower" time in the department ) it sounds like a good patient handoff (safety) process. Unfortunately, it may not work out for everyone for multi factorial reasons, which are too many to discuss here. The old cliche of one size fits all does not apply to the discussion at hand. If it seems to work for one site the more power to them. Leaders lead by example so in my opinion if this is a process the PICU wants roll out (request, mandate) then I feel when looking at it from the perspective of all stakeholders that the PICU should volunteer in bringing the team down to the ER for the handoff to take place. Maybe by the time they arrive the next PICU patient is ready for handoff, and saves the PICU team a second trip down :-). I can see both sides of the issue but in general the PICU is usually better equipped (volume, flow, one on one nursing,etc) to come down to ER rather than the other way around. Every place is unique and ultimately doing what's right for your patient(s) is the most important thing.... the answer to what's right is unique to everyone's setting so only those at the ground level at your site can answer that question.... my guess is majority of Peds ER's will struggle with that model and will decide not to do it when weighing all pros and cons...
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Dennis A. Hernandez, MD, MBA, FACEP
Medical Director, Pediatric Emergency Services
Immediate Past Chief, Florida Hospital for Children, Walt Disney Pavilion
Florida Emergency Physicians
Core Faculty, Florida Hospital Emergency Medicine Residency Program
Assistant Professor, University of Central Florida School of Medicine
Assistant Professor, Florida State University School of Medicine
> On Aug 11, 2017, at 1:45 AM, Semple-Hess, Janet <[log in to unmask]> wrote:
> We have for many years had a fellow or resident accompany patient to PICU. Yes it slows things down for 15-20 minutes but none of us has questioned the value of this.
> Janet Semple-Hess
> Children's Hospital Los Angeles
> Sent from my iPhone
>> On Aug 10, 2017, at 11:11, Michael S. Mitchell/Emergency Medicine <[log in to unmask]> wrote:
>> Good afternoon.
>> Our PICU physicians are asking that all PICU admissions from the ED have a bedside handoff in the PICU. Basically, they want a senior resident/PEM fellow to escort the patient to the PICU (about 6-7 min away from the Peds ED) and then give a detailed hand-off (much like rounding) to a multi-disciplinary team in the PICU including RN, MD, and RT.
>> Their request is incredibly costly for the peds ED as our residents and fellows are usually not expendable.
>> Have other institutions tried this and found a way that it works? We certainly see the benefit for that one single patient, but it comes at a cost of caring for the rest of the ED.
>> Thanks in advance for any advice you can offer.
>> Michael Mitchell, MD
>> Medical Director-Pediatric ED
>> Michael S. Mitchell, MD
>> Assistant Professor of Emergency Medicine
>> Section of Pediatric Emergency Medicine
>> Wake Forest University School of Medicine
>> Medical Center Boulevard
>> Winston-Salem, NC 27157
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