Taking the ‘ouch’ out of the ER
MID-CITY — No one likes going to the emergency room, and that sentiment is felt even more profoundly by small children for whom the fear of pain is not tempered with the experience brought by age.
Doctors at the UCLA-Santa Monica Medical Center are working to transform their emergency department into a child-friendly environment with new tools and technologies that take some of the pain out and respond directly to the unique needs of children.
The creation is rather hopefully called the “ouchless ER,” and it aims to change not only medical practices, but the environment in which they are performed to make the full package more “kid friendly.”
That means a new paintjob and more easily-sanitized toys on the one hand and on the other a $25,000 ultrasound that helps find a child’s veins the first time — children have more body fat and it’s hard to find the vein.
The department has also introduced mucosal atomizers, a device that loads painkillers through the nasal passages rather than a more painful needle.
“We’re trying really hard to introduce ways to use anything but a needle,” said Dr. Lisa Dabby, the doctor heading up the conversion to the “ouchless ER.”
The switch is personal for Dabby, a mother of two who has had to take her own children to the doctor’s office and knows the special kind of fear that parents can have when it’s their kid on the examining table.
“I’ve been on the other side … . I feel very strongly about taking good care of kids,” Dabby said.
The changes represent a paradigm shift in how to treat not only children, but the concerned families that come into the sometimes scary emergency room environment with them, said Dr. Wally Ghurabi, the medical director of the Nethercutt Emergency Center at the hospital.
“There’s a hectic pace in the ER, but (pediatric patients) need more time,” Ghurabi said. “You’re treating them, but you’re treating their family too.”
It’s a critical move for UCLA-Santa Monica, which is one of the few hospitals with an emergency department and intensive care unit specifically for children and sees the majority of young patients in the Westside.
Roughly 18 percent of the 40,000 patients that the emergency department treats each year are children, Ghurabi said.
Some of the technologies have been around for awhile, but needed to go through intensive trials to ensure they were appropriate for use with children, like the atomizers, which have been in the field for almost seven years.
Another critical addition to the ER was not a “what” but a “whom.”
The hospital hired a child development expert named Katie Kolbeck specifically to interface with children and their families to make the stressful ER experience easier on all sides. She talks them through treatments and engages with them to make sure they’re comfortable.
It’s a big boon for the doctors who are used to running through the emergency room at a breakneck pace not having the time to sit down and make a connection with the patient.
“It’s a huge help,” Dabby said. “She’s already established a rapport with them, talked them through what you’re doing. She thinks about it from the child’s point of view. Doctors are so busy focused on the medicine, they may not have the time.”
It’s been roughly two and a half years since the conversations first got going about converting the emergency room into a kid-friendly space, and some of the changes are still underway.
The ER has sectioned off a room that will be completely revamped with children in mind, from comforting paint jobs to a couch so that the child can lay down with their parents while they wait for a doctor to arrive rather than be isolated on the cold medical bed.
Training and access to child-specific treatment information are also components of the change.
The ER doctors run drills once a quarter to practice techniques to resuscitate badly injured or ill children, skills that are critical in the situation but are rarely needed.
Roughly 10 of the nurses have been trained to use the new vein-finding ultrasound, a number that will grow when a new class is held in March. Ultimately every member of the nursing staff will be trained to use the devices, Ghurabi said.
The hospital also invests in Pemsoft, a software reviewed by 23 experts in pediatric medicine that delivers instant treatment and diagnosis information to busy emergency room docs to ensure the best practices are used on children every time.
It’s a good tool to have in a pinch because treating children is hard, not just in the practice of the medicine, but on the staff’s emotions, Ghurabi said.
“Docs and nurses are emotional,” Ghurabi said, and many people see their own children in the young person that they’re treating.
That makes the success of the project personal, and the doctors involved want to cement UCLA-Santa Monica Medical Center as a recognized place to take children for top-notch medical care.
“We’re trying to be the best west of the 405,” Dabby said.
