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AS someone who is dual trained and spends most of my time in a tertiary peds ED, I understand both sides.  To me the key is your location, resources and established partnerships.  As an ER doctor and ED first, all providers need to be ACLS ready.  If Grandpa drives up to the big red ER sign and arrests, we need to be ready to resuscitate and stabilize.  It's expected of an ER doctor.  Depending on your proximity to an adult or General ED and established relationships, your time with this adult patient may be limited. There are certain adult emergencies that all docs staffing and ED should be ready.  time is muscle and time is brain.  We certainly owe it to adults in trouble to get them to definitive cardiac or neuro care in the established timeframes.  There are so few peds only ED's that are so distant form and adult center that with good relationships and preplanning, 60 minutes door to balloon or 120 minutes to TPA for stroke should be expected.

To stir the pot even further, what about teens(or adults) in labor, particularly those that present with imminent delivery at hand...



-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Chavda, Kamal
Sent: Tuesday, April 22, 2014 3:49 PM
To: [log in to unmask]
Subject: Re: Adult patients in the PED

Hi  Dr. Flood,


The question is not about patient showing up to a pediatric ED. That part is clear---If they show up all they need is screening exam and transfer them appropriately.

The question was --- Hospitals where the pediatric and adult ED are adjacent to each other (separated by doors) the management at several institutions wants pediatric ED to take some of adult ED patients to ease the flow and waiting times etc ( Not to mention- improve customer service satisfaction- PG score)


I had to do that sometimes out of courtesy for my adult ED colleagues when they got slammed ( did so very reluctantly and cherry picked patients)

Other than not wanting to see adults as we chose to do pediatrics, my question would be.......

If one is PEM trained  ---What does your malpractice insurance say in terms of age? Does it specify age?  In the event of a law suit could you be on your own?


KKC,MD

________________________________________
From: Pediatric Emergency Medicine Discussion List [[log in to unmask]] on behalf of Robert Flood [[log in to unmask]]
Sent: Tuesday, April 22, 2014 3:02 PM
To: [log in to unmask]
Subject: Re: Adult patients in the PED

Hi everyone:

Regardless of the age range you care for in your ED, this entire conversation really focuses on two issues: Scope of Practice and EMTALA.

EMTALA reigns supreme on all issues as it pertains to EM. As a physician in an ED, you must provide stabilization to the best of your hospital's and your personal capabilities. Since the training, expertise and experience of EM physicians vary greatly, everyone should keep these simple principles in mind.

As such, I give the following advice to my staff:

1) All adult patients who present for care in our ED must have an EMTALA screening examination.
2) The extent of that screening examination is determined by your hospital's and your personal level of comfort of managing that patient to the point of Discharge or Transfer.

For those who feel really uncomfortable managing adult patients, the extent of the medical screening will be much less than for say me, who trained in adult medicine.

Lets not make this more complicated than it needs to be.

Just my two cents.

Bob Flood
Division Director, PEM
Cardinal Glennon, St. Louis


On Tue, Apr 22, 2014 at 11:02 AM, Marjan Askar <[log in to unmask]>wrote:

> I just wanted to point out that suturing a 30 year old May not be 
> different than the 15 year old, but the bottom line is that those of 
> us who chose to do a pediatric emergency fellowship following a 
> pediatric residency, are PEDIATRIC sub specialists.
> We CHOOSE not to see adults .
> Same argument goes for a heart surgeon performing general surgery .  
> Are the able to and trsined? Yes They CHOOSE not to.
> This issue comes up where I work all the time.
> In the era of see as many patients as quickly as you can and keep 
> patients satisfied , physician satisfaction with what they do is forgotten .
> I simply CHOOSE to take care of kids.  This is what satisfies me.
>
> Marjan Askar
> Lake Forest, IL
>
>
> Sent from my iPhone
>
> > On Apr 21, 2014, at 7:46 PM, "Linzer, Jeffrey F" <[log in to unmask]>
> wrote:
> >
> > Not to drag up too many old issues, but PEM's are emergency 
> > physicians
> first. Yes, everyone who came up the peds track did only four months 
> of adult time and that won't make you an expert in figuring out 
> whether to start TPA on that 52 year-old who is having an evolving stroke or not.
> However, I think doing a laceration repair on a relatively healthy 40 
> year-old isn't that much different than a 15 year-old.
> >
> >
> >
> > That said, the only "legal" issue is what services you are 
> > credentialed
> by the hospital to perform (other than the occasional emergency 
> surprise that may so up at your door). If you work in a dual ED 
> (adults and kids in the same basic area), then the hospital is 
> responsible for making sure you are qualified to perform/provide 
> services to certain patients. The breakdown of peds care ending at 15, 
> 17, 20 or 25 is purely artificial and based on your specific 
> hospital's policies. In fact the AAP recognizes "young adults" (to age 
> 26) under the purview of pediatrics (Guiding principles for managed 
> care arrangements for the health care of newborns, infants, children, 
> adolescents, and young adults. Pediatrics 2013;132;e1452).
> >
> >
> >
> > So with that said, as long as the hospital has said your are 
> > qualified
> to perform a service (and your malpractice carrier agrees) than you 
> can go ahead and provide the service.
> >
> >
> >
> > Just my 2₵
> >
> > Jeff
> >
> >
> >
> >
> >
> > Jeffrey Linzer Sr., MD, FAAP, FACEP
> > Associate Professor of Pediatrics and Emergency Medicine Emory 
> > University School of Medicine Associate Medical Director for 
> > Compliance EPG/Division of Pediatric Emergency Medicine Children’s 
> > Healthcare of Atlanta
> >
> > [cid:[log in to unmask]]
> >
> >
> >
> >
> >
> >
> >
> >
> > -----Original Message-----
> > From: Pediatric Emergency Medicine Discussion List [mailto:
> [log in to unmask]] On Behalf Of Lisa A Drago
> > Sent: Monday, April 21, 2014 3:13 PM
> > To: [log in to unmask]
> > Subject: Adult patients in the PED
> >
> >
> >
> > Recently our adult colleagues have been requesting the PEM docs see
> young adults ( under 30) when their volume becomes unbearable. Any PEM 
> docs seeing young adults in your practice and legally how are you 
> handling this (separate hospital privileges?)
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L The URL 
> for the PED-EM-L Web Page is:
> >
> >                 http://listserv.brown.edu/ped-em-l.html
> >
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