RESUMO
OBJECTIVES: This study aimed to describe the design and implementation of an alternate site of care (ASC) for nonurgent pediatric patients with influenza-like illnesses during the 2009 H1N1 pandemic and to evaluate its performance. METHODS: We describe the design and physical implementation of an ASC. Evaluation of the utilization, patient demographics, throughput, safety, family satisfaction, and cost are presented. RESULTS: The process of project development, site selection, clinical algorithms, staffing supplies, and cost are detailed. The ASC was used for 7.5 days, and 137 patients were treated. The median age was 6.5 years. Forty-five percent were male, and English was the primary language. Median length of stay for patients evaluated was 65 minutes. Of patients, 5.8% were transferred from the ASC to the ED for further care. Also, 2.3% of patients returned to the ED within 72 hours; however, none required admission. There were no adverse events associated with the ASC and 92% of families rated overall care as very good or excellent. CONCLUSIONS: Selected nonurgent patients with influenza-like illness during a pandemic can be treated in a safe and timely manner with high levels of family satisfaction in a novel setting.
Assuntos
Hospitalização/estatística & dados numéricos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Pandemias , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Massachusetts/epidemiologia , Estudos Retrospectivos , Adulto JovemAssuntos
Analgésicos/administração & dosagem , Fraturas Ósseas/complicações , Dor Musculoesquelética/tratamento farmacológico , Manejo da Dor/normas , Medição da Dor/efeitos dos fármacos , Analgésicos Opioides/uso terapêutico , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Esquema de Medicação , Educação Continuada , Serviços Médicos de Emergência/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Humanos , Infusões Intravenosas , Masculino , Dor Musculoesquelética/etiologia , Manejo da Dor/tendências , Radiografia , Resultado do TratamentoRESUMO
OVERVIEW: The suicide rate among children and adolescents has increased worldwide over the past few decades, and many who attempt suicide are first seen at EDs. At Childrens Hospital Boston (CHB), an algorithm-the Risk of Suicidality Clinical Practice Algorithm-has been developed to ensure evidence-based care supported by best practice guidelines. The authors of this article provide an overview of pediatric suicide and suicide attempts; describe screening, assessment, and interventions used at CHB; and discuss the nursing implications. An illustrative case study is also provided. KEYWORDS: algorithm, Asperger's syndrome, attempted suicide, bullying, emergency, emergency department, patient safety, pediatrics, pediatric suicide, suicide, suicide screening, triage.