for one thing, it markedly diminishes the chances of any real emergency being present in any one kid.
i teach it as the all-in-one sign and believe (anecdotally) it has a high sensitivity for lack of badness.
(exceptions recognized)

----- Original Message ----- 
From: "Dave Smith" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, August 10, 2009 9:56 PM
Subject: "Family Plan" Visits

Due to a recent that has come up in my institution, I was curious how other centers handle "family plan" visits. This refers to the family bringing multiple children to the PED for mostly minor chief complaints. For the sake of this discussion, we will assume none of the children has a significantly emergent medical problem (no asthmatics with 80% room air sats, no one in severe DKA, no septic neonates). 

Let's take three scenarios (assume the children are fully immunized, no other problems except what's noted below, etc):

A. Two siblings: 8 year old, 6 year old...both with 101 fevers and sore throats for 2 days, otherwise healthy, mother states she "wants check for strep"

B. Three children: 8 year old, 3 year old, and 11 month old--8 year old has asthma and has been coughing but is is out of meds and wants a refill, child is wheezing but in no distress and room air sats are 96%, the 3 year old and 11 month old have ringworm

C. Four children: 15 year old with forearm pain from a blow in football practice yesterday, 10 year old with ear pain, 5 year old who has thrown up three times today and had a fever of 101, and a 2 year old who just started with fever 6 hrs ago, no other symptoms.

The question is how you handle these visits at your institution:

1. Do you register and triage them together, putting them all in the same room to be seen simultaneously?
2. Do you register and triage them together, but only put them in a room one at a time, seeing the next one only after the previous one is evaluated/dispositioned?
3. Do you do everything separately...meaning having the first child be registered, triaged and evaluated before the next child goes through the process?
4. Do you do something else?
5. Does how you handle theses family visits change depending on scenario's A, B, or C? 
6. Do you have any written policy regarding these kinds of visits or are they handled mostly by "common law" procedure? 
7. Have concerns been raised regarding medical errors in rooms with multiple children from one family and have any steps been taken to address those concerns with formal policies or procedures?

If you don't wish to bog down the list with the replies, just reply directly to my email address. I thank everyone in advance for their input.

R. David Smith, MD
Children's Acute Care


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:

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: