Print

Print


Free standing Children's hospitals do not have the luxury of triaging
patients to "age appropriate" settings without a medical screening exam
and stabilization. Our expectation of the community pediatricians is that
they will start transition their adolescent patients (based on levels of
maturity, comfort level and underlying medical condition rather then their
chronological age) to appropriate adult care. However, our stance in the
pediatric emergency center is that once the patient shows up for care in
the ED, we will provide the full spectrum of care up to the age of 21
(more in the case of CF and congenital heart). Older patients voluntarily
enter our system, they are not "shown" there. A community hospital with
both adult and pediatrics care can very appropriately triage at a lower
cut-off age.
Naghma S. Khan, MD
Children's Healthcare of Atlanta at Egleston



  [log in to unmask] writes:
>I am persistently astounded by the ever-enlarging definition of
>"Pediatric".
>I got married, graduated from college and started medical school when I
>was
>21. I would have been sorely insulted had I been shown to the PED if I had
>gotten sick at that time.
>
>JM
>
>John L. Meade, MD, FACEP
>Chief Executive Officer
>Emerald Healthcare Group, P.A.
>Doctor's Resource Group, Inc.
>http://www.statdoc.com/
>
>-----Original Message-----
>From: Pediatric Emergency Medicine Discussion List
>[mailto:[log in to unmask]]On Behalf Of Geoffrey Capraro
>Sent: Monday, September 10, 2001 13:52
>To: [log in to unmask]
>Subject: 18-21 year olds
>
>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
>
>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:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html