Caring for a Child's Unique Needs: PA Health Network Plans Pediatric ED

To meet increasing demand for pediatric care, Lehigh Valley (PA) Health Network has announced plans to establish a pediatric emergency department. The facility will be constructed in space adjacent to the current emergency department at Lehigh Valley Hospital Center-Cedar Crest in Salisbury Township, PA, and is expected to be completed in spring 2011.

Richard MacKenzie, MD, LVHN chair of emergency medicine, says the existing ED at LVH-Cedar Crest cares for 13,000 children a year. The demand for pediatric medicine at that location had reached a volume in which a pediatric ED was something to be considered, and LVHN would have had to expand the existing ED in a few years anyway to meet that demand, he says.

In addition, MacKenzie says there is no ED specializing in pediatric care in the Lehigh Valley region that is located on the eastern border of Pennsylvania.

"This service is not available to Lehigh Valley residents unless they drive over an hour east, west, or south," MacKenzie says. "Some of the Valley's children with complex illnesses do drive that distance to receive that service and we feel it would benefit them to receive the care closer to home."

Nationwide, an Institute of Medicine report in 2006 found that only about 18% of pediatric emergency visits are to a children's hospital or a general  hospital with a pediatric emergency department. The report also said about 6% of U.S. hospitals have all the supplies to take care of children, such as pediatric endotrachial tubes and resuscitation equipment.

The 6,700 square-foot pediatric ED will include 11 treatment rooms and a separate waiting area for pediatric emergency cases. It will feature staff specially trained to care for children, including pediatric emergency medicine physicians, pediatric emergency nurses, and a child life specialist to assist children and their families with the psychological and social issues that sometimes result from an ED visit, MacKenzie says.

The purpose of the LVHN pediatric ED is to treat children as children, MacKenzie says. Many of the physicians will have completed a three-year fellowship in pediatric emergency medicine after graduating from either an emergency medicine or pediatrics residency.

"Of utmost importance is that all personnel will have a passion for treating children— they dedicate themselves to acquiring special knowledge necessary for that task" he says. "The chief philosophy will be to remain sensitive to children's and parent's needs."

A child-friendly atmosphere is critical, MacKenzie says, because it is often difficult for children to be in an environment where adults are suffering from illness or injury. From a disease standpoint, there are many illnesses that only affect children, and the new pediatric ED will put protocols in place to address these conditions, he adds.

The ED will feature special attention to employing state-of-the-art pain reduction methods, with a goal to manage a child's pain through staff education, consistent assessment criteria, implementation of protocols, and technology. There will also be a child life specialist on site to interact with the children and allay their fears. According to MacKenzie, research has shown severe pain and worry can stick with children for a long time, and even permanently.

"Innovation in pediatric care will reach the bedside faster here—the dedication to new knowledge in this specialty area will create the situation where this will occur," he says. "From a satisfaction standpoint . . . this will be a brightly colored, fun-looking space designed to lift one's spirit even in times of suffering."

MacKenzie adds that the creation of pediatric emergency departments at other U.S. hospitals has shown that a separate space for such treatment can further reduce wait times for both child and adult emergencies.

John Van Brakle, MD, LVHN's chair of pediatrics, says an emergency room dedicated to serving the needs of children is the next logical step for the network.

"We currently offer our young patients and their families access to a wide range of specialty care services, including a specialty care center, pediatric intensive care unit—the only one in the region—neonatal intensive care unit, and the most experienced trauma center in the region treating adults and children," Van Brakle said in a statement. "A pediatric emergency department would take the care of children, especially those with special healthcare needs, to the next level."