Spotlight on Pediatric Emergency Care Volume 2, Issue 1, January 2004 Child-life in the Emergency Department: A Real Winner First, I want to take a moment to wish everyone a Happy and Healthy New Year. We are all working in a difficult and challenging healthcare system, which can be stressful for both ourselves and the patients we're trying to serve. If we're in this for the long run, I believe it is essential that we figure out how to engage in this work in a manner that can sustain, and even reinvigorate us. The challenges and difficulties will always be there; how we respond to those challenges is the moment when we have the power to make a difference for ourselves and others. In this issue I focus on child-life services as a tool for enhancing emergency care for children. This particular service can distinguish exceptional pediatric emergency services from just good ones. What is Child-life? I am often asked exactly what child-life is all about. Most children's hospitals have child-life specialists on the inpatient services. These are individuals who after obtaining a Bachelor's degree, have an additional one year college-based practicum, followed by an internship with 400-600 hours of experience in a hospital child-life department. Child-life specialists help children and families prepare for and better manage procedures or surgery. They also help children who are frightened to better cope with hospital surroundings. More recently, many children's hospitals have started to bring child-life expertise into their emergency departments. In this setting, child-life specialists take on a variety of roles, all of which result in reduced anxiety for children, and an overall significant increase in satisfaction for the entire family. As a Pediatric ED director, I received dozens of letters over the years from families grateful for these dedicated specialists. Many of these families expressed their apprehension at coming to the emergency department with an ill or injured child, and the radically improved experience they had from what they expected. Not all child-life specialists are cut out for working in emergency departments. As with other staff, it requires individuals who are able to efficiently and effectively establish relationships with families they have never met. Here are some of the roles they can take on: Prepare children (and parents) for procedures such as IV insertions or blood draws, laceration repairs, lumbar punctures, etc. They are usually able to effectively prepare a child in 5-10 minutes, recognizing the need to maintain patient flow in a busy department. Use distraction techniques individualized for the particular patient during procedures. These might include story telling, picture books, music, toys, or blowing bubbles. These techniques can be so effective, they allow us to avoid the need for sedation in otherwise very anxious children. Engage a moderately sick appearing toddler in play activities to help rapidly discern whether the child is seriously ill or just cranky and unhappy to be in the emergency department. When not busy with other tasks, simply go into rooms where families are waiting, to see if they need anything and make them more comfortable, through conversation and engagement of the child. Does Child-life Make Sense for My ED? To justify the expense of this service, a pediatric volume of at least 15,000- 20,000 children per year is reasonable. This volume should keep the child-life specialist busy, at least during the peak afternoon and evening hours. The good news is that even community emergency departments that see a lower volume of children can take advantage of at least some of this special expertise. Many of the distraction techniques can be learned by the nursing staff, through focused training and practice. For this to work, it is essential that the staff be motivated to improve the experience that children and families face as they enter the department anxious and apprehensive. If your department takes care of 5,000 children per year or more, I strongly encourage you to consider incorporating this specialized focus into your service line. If done right, it will improve clinical care, while simultaneously creating a much improved experience for the families you serve! About Our Organization Created in 2003, Petrack Consulting is dedicated to helping physician and hospital leadership bring excellence to emergency services for children. We work collaboratively to fully understand our client’s needs, and then address programmatic initiatives with measurable outcomes. Our unique background in pediatric emergency medicine, administrative medicine, and organization development allows us to create uniquely effective solutions for enhancing emergency services for children.