Middletown Emergency Dept. earns Pediatric Ready designation

Since it opened four years ago, Christiana Care’s Middletown Emergency Department has treated more than 17,000 children – an average of 14 per day – for everything from fevers to broken bones to respiratory distress. Now, that expertise has earned the facility the designation of Level 4 Delaware Pediatric-Ready Emergency Department.

That means the center and its staff are specially equipped, trained and prepared to treat pediatric emergencies.

To give parents even greater peace of mind, Delaware was a demonstration state for the pediatric-ready initiative by the national Emergency Medical Services for Children (EMSC) program. All Delaware hospitals participated.

“These kinds of designations hardwire standards into a proactive environment and support ongoing excellence,” said , said Linda Laskowski-Jones, MS, APRN, ACNS-BC, vice president of emergency and trauma services for Christiana Care. “It’s a source of pride for the staff, and the staff in Middletown deserves recognition. Most importantly, it keeps us in a state of readiness to handle whatever type of patient comes through that door.”

Last year, guidelines were drafted by the Delaware EMSC program, and a new level was added to include freestanding departments — those not connected to a hospital — in the review process, said David Salati, BSN, RN, CPEN, CCRN, MICP, pediatric nurse coordinator for the department.

Previously, only hospitals could apply for three levels of distinction. Dedicated children’s hospitals can qualify for Level 1. Christiana Hospital is Level 2, and Wilmington Hospital is Level 3.

Erin Watson, M.D., FACEP, medical director for the Middletown Emergency Department, said the recognition reflects their mantra: “We want to provide great health care to the community in the community.”

And that community is growing. From 2000 to 2010, Middletown’s population swelled more than 206 percent, to 18,871 from 6,161, according to U.S. Census figures. It was projected to have grown another 10.6 percent, to 20,876, by 2016.

The Middletown Emergency Department includes a dedicated child resuscitation room ready to treat newborns and older children. It holds warmer beds for babies and an infant-specific pediatric ventilator, among other specialized equipment. The waiting area features child-sized furniture, and the televisions are locked onto programs appropriate for younger patients.

Pediatric patients, considered to be age 14 and under, aren’t just “little adults,” said nurse manager Kara Streets, BSN, RN, MS, CEN, NE-BC.

“What works for an adult may not work for a child,” Streets said. “Take something as simple as CPR — we’re going to focus on respiratory, not circulation, as you would in an adult. If you fix the respiratory issue first in a child, the cardiac arrest likely is not going to occur.”

Equipment, too, must be able to fit all shapes and sizes. Whereas one or two sizes can be enough to accommodate most adults, children will require half a dozen, she said. The patient’s weight must be considered when dispensing medicine, and treatment must be catered to children’s developmental stages, which can vary greatly in even a year. Then there are the intangible skills needed to be able to put a child at ease when, for example, scary things like needles are involved.

And children can’t always tell you what’s going on.

“You have to talk to them at their level and reassure them you’re going to take care of them,” Dr. Watson said, adding, “Sometimes, the toughest part of taking care of the kids is taking care of their parents — their child is sick, and they’re scared.”

To communicate with parents who don’t speak English, a video-enabled service is available to provide a real-time, personal translator.

Many states don’t have such a pediatric review system, Laskowski-Jones said. “That can be a scary thing if you’re a parent and have a sick child, because you don’t know if that weird-sized chest tube is going to be available, or if the staff has ever experienced this type of situation.”

Stefanie Golebiewski-Manchin, M.D., pediatric physician coordinator for the department, called the new designation “extremely important.”

Parents can rest easily knowing that regardless of where they live in Delaware, their closest emergency department is prepared to provide their children high-quality skilled care.

“The biggest thing is it assures the community that we’re prepared to handle every pediatric patient that comes in that door, no matter what,” Dr. Golebiewski-Manchin said.