Why Canada must in­vest in kids’ emer­gency care

Chil­dren are not small adults: So some non-pe­di­atric spe­cial­ists may lack re­quired skills

The Hamilton Spectator - - COMMENT - DR. TERRY KLASSEN AND LEAH CROCK­ETT

When a child is sick or in­jured, our health sys­tem usu­ally de­liv­ers ex­cel­lent care. That’s good news. Yet the adage that “chil­dren are not small adults” — and have spe­cific med­i­cal needs — re­flects the chal­lenge still fac­ing most Cana­dian emer­gency de­part­ments.

Each year in Canada, ap­prox­i­mately 1.8 mil­lion acutely ill and in­jured chil­dren will visit an emer­gency depart­ment. What most Cana­di­ans don’t re­al­ize is that ap­prox­i­mately eight in 10 of those kids will be cared for in a gen­eral emer­gency depart­ment with var­i­ous lev­els of pe­di­atric care ex­per­tise. Why is this im­por­tant? Rec­og­niz­ing red flags early and start­ing ap­pro­pri­ate treat­ment can mean the dif­fer­ence be­tween life and death for kids in emer­gency care.

The unique med­i­cal needs of chil­dren present a spe­cial chal­lenge for emer­gency care providers.

Some gen­eral emer­gency de­part­ments may not see very many sick chil­dren, so when they do have to pro­vide care for kids in med­i­cal cri­sis, some es­sen­tial skills may not be sec­ond na­ture to non-pe­di­atric spe­cial­ists.

Skills like pro­vid­ing the right dosage of med­i­ca­tion ac­cord­ing to child weights or un­der­stand­ing age-ap­pro­pri­ate vi­tal signs are crit­i­cal in an emer­gency set­ting.

De­vel­op­ing pe­di­atric ex­per­tise in gen­eral emer­gency depart­ment set­tings can also be dif­fi­cult.

Cer­tain health con­di­tions in chil­dren oc­cur in­fre­quently and ac­cess­ing pe­di­atric­spe­cific train­ing can be a chal­lenge.

As a re­sult, car­ing for a very sick child is of­ten the No. 1 dis­com­fort for many gen­eral emer­gency depart­ment health care pro­fes­sion­als.

And keep­ing up on the lat­est ev­i­dence can be near to im­pos­si­ble. Th­ese knowl­edge gaps are also costly. Take for ex­am­ple, croup and gas­troen­teri­tis. Sim­ple and in­ex­pen­sive medicines can re­duce hos­pi­tal­iza­tion rates by as much as 86 per cent and, thus, sig­nif­i­cantly re­duce health care costs.

Yet, the rec­om­mended med­i­ca­tions aren’t used as of­ten as they should be, which means both the health of the child and the well-be­ing of the health sys­tem are po­ten­tially jeop­ar­dized.

It has been es­ti­mated that rou­tine ad­min­is­tra­tion of on­dansetron to chil­dren with gas­troen­teri­tis, for ex­am­ple, would pre­vent 4,065 in­tra­venous in­ser­tions and 1,003 hos­pi­tal­iza­tions an­nu­ally — and would save the health care sys­tem $1.18 mil­lion per year.

The level of emer­gency care for chil­dren varies widely across the coun­try and some­times the re­sults can be dev­as­tat­ing.

In re­cent news, there has been a spate of mis­di­ag­noses in Cana­dian emer­gency de­part­ments in­volv­ing chil­dren. Un­for­tu­nately, such tragedies, while not com­mon, are any­thing but new. So what’s the so­lu­tion? A na­tional pro­gram based in Man­i­toba is work­ing to share the vast knowl­edge and ev­i­dence pro­duced at chil­dren’s hos­pi­tals across the coun­try with com­mu­nity hos­pi­tals and nurs­ing sta­tions so that all chil­dren re­ceive the same level of ex­cel­lent care no mat­ter where they live.

Called, Trans­lat­ing Emer­gency Knowl­edge for Kids (TREKK), the pro­gram fo­cuses on pro­vid­ing cur­rent in­for­ma­tion on the recog­ni­tion and treat­ment of the most se­ri­ous con­di­tions af­flict­ing chil­dren.

TREKK cre­ates both clin­i­cal tools that doc­tors and nurses can ac­cess when treat­ing a pa­tient, but also pro­vides out­reach ses­sions, sim­u­la­tion train­ing and a net­work that bet­ter con­nects ru­ral, re­mote and ur­ban com­mu­nity hos­pi­tals to their clos­est chil­dren’s hos­pi­tal. But more can be done. While a few dozen gen­eral emer­gency de­part­ments are us­ing TREKK, there are about 1,400 other emer­gency fa­cil­i­ties that could ben­e­fit from such re­sources — and aren’t.

It is time fed­eral and pro­vin­cial gov­ern­ments in Canada in­vest in a knowl­edge in­fra­struc­ture so that health care providers can ac­cess TREKK at the point of care of acutely ill and in­jured kids. It’s time to scale up, in other words.

Are we ready to com­mit na­tion­ally to emer­gency care for chil­dren?

Dr. Terry Klassen is an ex­pert ad­viser with Ev­i­denceNet­work.ca and CEO and sci­en­tific direc­tor of the Chil­dren’s Health Re­search In­sti­tute of Man­i­toba. He is also the head of the depart­ment of pe­di­atrics and child health at the Univer­sity of Man­i­toba and direc­tor of Trans­lat­ing Emer­gency Knowl­edge for Kids (TREKK), funded by the gov­ern­ment of Canada’s Net­works of Cen­tres of Ex­cel­lence. Leah Crock­ett is a knowl­edge bro­ker for TREKK and the Knowl­edge Trans­la­tion Plat­form at the Ge­orge & Fay Yee Cen­tre for Health­care In­no­va­tion.

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