'We see ourselves as something of a family': An emergency department with children in mind

Children deserve a special emergency department, Dr Rory O'Brien tells Collette Sheridan

Tue, 08 Dec, 2020 - 07:24

Colette Sheridan

DESPITE being only 12 years old, Emily Booth is something of an old hand at hospital emergency departments (ED) for children. This eloquent girl, who lives in Brighton, was on one of her regular holidays to Cork in August where her mother Noelle O’Riordan is from. She was skateboarding outside her aunt’s house in Carrigaline when she fell and broke her wrist. She has had at least 20 breaks in her young life, a result of having the genetic disorder osteogenesis imperfecta. A collagen imperfection, it causes bones to be brittle and prone to fractures. Emily inherited the condition from her father.

She was treated at the children’s emergency department at Cork University Hospital (CUH) for the accident to her wrist. She had been there twice before, while holidaying in Cork. Emily appreciated the fact that the medics knew immediately what was wrong with her.

“On past experiences in other hospitals, we’ve had to explain what my condition is,” says Emily. “But at CUH, they knew because I was there before.”

When she was admitted, she was in a lot of pain. “I was given painkillers straight away. Dr Rory O’Brien (consultant in emergency medicine at CUH) stayed quite calm and was really funny. He spoke to me in the right way for my age. Some doctors, when I tell them my age, treat me like I’m younger.”

Emily has been to hospital in Brighton and is under the care of consultants at Great Ormond Street Children’s Hospital in London. How does CUH compare? “I’d say their method of doing things is slightly different but it’s still along the same lines.”

Emily didn’t have to stay overnight at CUH. While under sedation, her wrist was manipulated and it was put in a cast. That was for a month, followed by a splint.

“She’s a determined little one,” says Noelle who, like her daughter, was delighted that they only had to spend four or five hours at the ED in August. “Emily was upset at first but the nurses were great at calming her down. Dr O’Brien was brilliant. There’s a fridge in the ED and he was able to get Emily an orange juice. The nurses were all in their colourful uniforms. They were really nice and caring, talking to Emily and checking in with her before they went near her wrist. We were talked through exactly what the osteo surgeon was going to do after the x-ray.”

What impressed Noelle was the way the staff spoke to Emily. “I was really just an accessory. Emily may only be 12 but she knows her stuff. At the same time, she was spoken to in an age-appropriate way. It was the kindness that shone through and the feeling that she was very safe in their hands.”

Noelle says that the aim was to alleviate the pain Emily was in. Also, she was treated with “respect and humour which goes a long way when it comes to a child that is frightened and is afraid of more pain. It was one of the best ED experiences Emily has had. She was cared for not just medically but emotionally as well. That made a massive difference. We came out of there smiling.”

Dr O’Brien is “very proud of what we’re doing here. We’re really punching above our weight”. Last year, CUH had more major paediatric traumas presenting to it than any other hospital in Ireland.

Children, he says, deserve a special ED. “I think we can all agree that (going to hospital as a child) can be a very scary and difficult time. Our job in CUH ED is to ensure that the experience is painless, both emotionally and physically. While this may seems like a far-off ideal, I can assure you that with properly trained health professionals and the right environment, this is very much possible.”

How is a children’s ED different to an adult ED? “Firstly, there are many similarities. We triage children at the front door and attend to each child’s emergency as quickly as we can. The principles of providing emergency care are broadly similar across both sides of ED. However, there are some important differences.”

Children have needs that are quite different to adults. “They are dependent on their caregivers and, as such, we can’t treat the child in isolation. We must treat the family. We are very much aware that for a child to thrive, they must have a network of supports with the family at the centre... I think we see ourselves as something of a family working together in the ED. Emergency care is a team sport after all.”

A child in ED needs to feel safe and secure in their surroundings. Dr O’Brien is confident the new ED will accentuate feelings of security. An artist working for an interior decor company has been hired to decorate the unit in an attractive and calming style that will be child-friendly. It will be a standalone unit, separated both visually and audibly from the other parts of the hospital.

In the past year, the children’s unit has been expanded. With the new building, the children’s ED will have 10 isolation bays, one of which will be a procedure room. There will be a resuscitation cubicle as well.

“Young children represent a challenging group because, depending on their developmental stage, they can be unable to reliably communicate with us, meaning that special expertise is required to safely and effectively assess this patient group. The clinical expertise required to manage these patients from a nursing and medical perspective lies somewhere between paediatric and emergency medicine. Through local and national models of care, we have bolstered this expertise in our ED and we hope to continue to develop this expertise within the region.”

Dr O’Brien says that to minimise potential distress caused by a procedure, “the child’s perspective needs to be front row and centre. We use every technique at our disposal to distract and divert attention away from any potentially unpleasant experiences. Sometimes we need to offer strong medications and we are very proud of our safety record in their use.”

It’s also important to take into consideration “neuro-atypical children who have difficulties in noisy and chaotic environments. These children require a special approach to ensure they get the best care and that they have a pleasant experience in our ED.”

On one occasion, a young boy’s arm was being put in a cast. “The nurse and doctor said they were making a bit of a mess pulling on the plaster cast but they would clean it up afterwards. The boy looked at them earnestly and asked: ‘But will I still be able to hug my mommy?’ That was his main concern. The nurse and doctor must have been doing a good job if that was all he was worried about. That’s one of the nice things about dealing with children. They’re very honest and are straight talkers. They’re resilient and can bounce back remarkably well, physically and emotionally.

While nobody wants to have to bring their child to an ED, Dr O’Brien wants everyone to know “that there will always be a