Pediatric Emergency Department: An Overview
Guest: Dr. Tim Givens – Pediatrics/ED
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m talking today with Dr. Tim Givens who is Medical Director of the new pediatric emergency department here at the MUSC. Dr. Givens, I understand that you’re relatively new to MUSC, having just come from Vanderbilt.
Dr. Tim Givens: That’s correct.
Dr. Linda Austin: Well, welcome.
Dr. Tim Givens: Thank you.
Dr. Linda Austin: We’re thrilled to have you here.
Dr. Tim Givens: I’m glad to be here.
Dr. Linda Austin: Now, many, if not most, medical centers do not even have a separate pediatric emergency department. What was the thinking, here, that we felt that it was important to do so?
Dr. Tim Givens: Well, I think there were a couple of different aspects to it, one being the volume of pediatric visits to the emergency department has grown through the years. It just became apparent that children being cared for in the same milieu as adults, with all their various problems, was not exactly beneficial to the children. So, several years ago, a move was made to establish a separate and independent care space for children.
Initially, the space that was found was an old clinic space. It served its purpose, but it was not logistically designed as an emergency department. So, we’re evolving as our volume grows, as the complexity of the cases grows, as our knowledge grows. So, we’re in a growth phase. We have now moved, within the last couple of weeks, into a refurbished space that has 12 beds, rather than 9 that we had before. These are actually emergency department rooms. They’re large. They’re brightly painted. They’re child-friendly. It looks like a pediatric place. And it’s all designed to enhance the cooperation of the children and their care, to put them at ease, to give us a better chance to interact with the families, do better exams, provide better care. Over the last several years and, I suspect, within the next several, we may need a new and bigger space because our volume has already put us at capacity in the two weeks that we’ve been there.
Dr. Linda Austin: And I would imagine that the facility is also designed to help families who are waiting with their children. Is that right?
Dr. Tim Givens: Yes, yes. So, for instance, in the waiting area, we have brightly painted murals. We play child-friendly DVDs, Dora the Explorer and Winnie the Pooh. There are child-friendly toys in that area, distraction items. Our department is staffed with social workers and child life specialists, people whose vocation is to assist in the care of the children, to distract them when they’re going to have painful procedures, match the families with resources in the community. Everything is set up so that you will have a child-friendly experience when you come in.
Dr. Linda Austin: I doubt that there’s a parent in the U.S. who has not had the experience of taking their child to an emergency department and knowing what a trying experience that can be, so it’s wonderful that we have resources to make that a little bit easier. Tell us about the staffing there. How many physicians will you have, nurses, physician extenders, nurse practitioners, and so forth?
Dr. Tim Givens: Currently, our core of physicians consists of eight full-time faculty. We’re recruiting two more and we have another one we’ve already signed to come in July. The vast majority of those folks have been fellowship trained and are board certified in pediatric emergency medicine. There are two or three of them that have just done it long enough that they’ve kind of grandfathered into doing the care and they’re excellent at what they do. We also have two nurse practitioners that work 12 hours each day. They see patients independently and run the cases by the faculty.
Then, we have a fast track/quick care area that we staff with our faculty, some moonlighters, general pediatricians, some of our chief residents, those kinds of folks, that take care of the colds, the sniffles, the earaches, those kinds of things, and, in parallel, take care of those patients so they get fast tracked through the ED; they don’t have to sit and wait for long periods of time.
Dr. Linda Austin: So, does that amount to a walk-in clinic, then, would you say?
Dr. Tim Given: It’s kind of a high-grade walk-in clinic. The folks there are, I guess, trained to handle emergencies if they had to, like if somebody got into that space and was sicker than they were billed. It’s designed to expedite care for people who have minor illnesses and injuries.
Dr. Linda Austin: Help me to understand that a little bit more. When I was raising my children, I took a trip to the emergency department quite seriously, not only for my kids but, also, in consideration of the use of resources. It sounds, though, as if one, for example, didn’t have access to a pediatrician, if you were a visitor in town, it’s not a true emergency for your child and yet you feel like they need to be seen, they have an earache and they can’t sleep or they’re screaming, or they have a fever, whatever, it’s a good option. Am I right about that?
Dr. Tim Givens: Yes. Our primary mission is to take care of the sickest of the sick, and that’s what our specialty is geared to. So, children who are in major car crashes, children who have shock or big infections, those kinds of things, that’s what we do best, resuscitate children. However, the vast majority of folks who come in don’t know whether they’re really that ill. Our, kind of, mantra is, if you think you have an emergency, come in and we’ll assess it. We’ll help you decide whether or not it is an emergency and treat the problem.
So, we don’t mind seeing people who are just concerned about their child, you know, they’ve been to see their doctor and they’re not quite sure. They want a second opinion. They want a diagnosis. They want someone else to look at them again and reassess and their doctor isn’t available, it’s after hours, they’re in pain in the middle of the night. Those things are also why we’re here, and we welcome that care as well.
Dr. Linda Austin: Let’s talk, now, if we could, Dr. Givens, about the true emergencies. Walk us through a typical day in the pediatric emergency department. What sort of true life-threatening emergencies do you see on a daily basis?
Dr. Tim Given: Well, you know, we’re a tertiary referral center, so we have a lot of subspecialists that care for children and we cater to a lot of their patients. So, for instance, children with complex congenital heart disease that have had heart surgery and are on a number of medicines that control whether or not they’re in heart failure, those kinds of things. We have children with cancer who are receiving chemotherapy and develop fevers and infections, other things of that nature. We have children who are injured in car crashes, falls, have broken bones, major lacerations, those kinds of things. For those kinds of things, we are the best place to get the care.
Let me give you an analogy. If you have a car, an Audi or a Mercedes, or something like that, and you’re driving down the highway and your battery dies or your fan belt goes, you can go to any place and get that taken care of because that’s bread and butter care. If you have something wrong with your electronic system, you know, the Shell station on the corner isn’t going to be able to handle it. You’re going to have to go to the dealer. So, we’re kind of the dealer, I think. We do the subspecialty high-end care for the people that need it. We also do the fan belts and the batteries and all that routine care as well.
There are people out in the community that can handle those kinds of things as well. But, a lot of times, we’ll get their referrals. People will go to urgent care centers or to their pediatrician and they’re not quite sure. Maybe it’s something more sophisticated or they don’t have the x-ray machine to do the next test or they don’t have the ability to run a blood count, those kinds of things, and they’ll send them to us. In a lot of cases, everything’s fine, but that’s why we’re here. We’re here to sort and to help, to figure out diagnostic problems and then get you on the right path to recovery.
Dr. Linda Austin: What is the telephone number for people who are facing an emergency and want to call in and get triaged?
Dr. Tim Givens: 911. I guess if you have a real emergency, that’s the number.
Dr. Linda Austin: Call 911?
Dr. Tim Givens: Right. Now, most often, we’re barred by legal considerations with dispensing medical advice over the phone without seeing somebody. So, if you call us, most likely we’re not going to dispense advice. We’re going to say, come on down, we’ll check you out. So, what we usually encourage people to do is call their primary source of care and, often, they’ll direct you to us if they feel it’s necessary. But, if you need to call the emergency department for some reason, our general number is: (843) 792-1269. That’s our main desk.
Dr. Linda Austin: Dr. Givens, thanks so much for talking with us today.
Dr. Tim Givens: Sure.
If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection: (843) 792-1414.