One year experience at the Emergency Unit of the Children's ...

ACTA BIO MEDICA 2003; 74; 34-37 © Mattioli 1885O R I G I N A L A R T I C L EOne year experience at the Emergency Unit of the Children’sHospital of ParmaTommaso Giacalone*, Maurizio Vanelli, Chiara Zinelli*, Angomeh Ndongko*, Juliette Ndaka*,Annachiara Casadei*, Daniela Nicoli* and Paediatricians on duty at The Children’s Hospitalof Parma (1)* Post-graduate Medical School of Paediatrics and Department of Paediatrics, University and General Hospital of Parma,Parma, ItalyAbstract. The objective of the study was to analyse the activity of the Paediatric Emergency Unit (PEU) ofthe Children’s Hospital in Parma, Italy, in the first year of its functioning. To this aim, the child’s chronologicalage, place of origin (town or province), ethnic group, cause of consultation, time and date of admission,diagnosis and final destination were retrospectively collected from the clinical notes of all children who attendedPEU from 1st. 10.1998 to 30th. 09.1999. During the period of this study 8,564 medical consultations(57% of users were male) were carried out by the Paediatricians on duty in the EU of The Children’s Hospital.The average age of the patients was 3.9±3.5 years. Only 7% of patients passed through the General EmergencyDepartment of the same Hospital. The peak period of consultations was found to be in February. Thenumber of daily attendances progressively increased from Monday to Sunday according to a r of 0.59 (p

Paediatric emergency35ber of attendance may interfere with the regular functioningof a PD, over-burdening the Paediatricians onduty who have to attend out-patients 24 hours a day, inaddition to the emergencies in the PD.The room of thePaediatrician on duty becomes in this way a veritablePaediatric Emergency-Unit (PEU) working just like aPED. However, compared with the PED, the PEU isnot autonomous and does not have its own individualstaff. In addition, some PEUs, just like a PED, have afew beds for a short clinical observation.In the background of this scenario, we haveanalysed the activity of the PEU of our Department inthe first year of its functioning.Material and MethodsThe information on patients of the PEU of ourDepartment concerned the first year of activity from1 st October 1998 to 30 th September 1999 and it wasretrospectively obtained from the clinical notes. Everychild admitted to the PEU was first attended by anurse who filled out a form detailing the vital parameters(heart beat, respiratory rate, body temperature,blood pressure), age, body weight and height. Notriage was made. The child was directly examined by aPaediatrician on duty. At the end of the visit, the childwas either discharged with a letter for the familyphysician or he/she was admitted to one of 6 beds adjoinedto the PEU for a short observation period.More serious cases were directly admitted to beds inthe appropriate specialized ward of the PD.The following data was collected by two of theAuthors (CZ and TG): the child’s chronological age,place of origin (town or province), ethnic group, motivefor consultation, time and day of admission, diagnosis,and destination.For statistical analysis t-student, ANOVA, chisquare,Pearson-linear correlation tests were performed.cent were males (males/females ratio 3:1). The averageage was 3.9±3.5 years (range 1.2 months - 19 years).Eighty-seven per cent of the patients were Italian citizensand 13% belonged to an ethnic minority. Ninety-threeper cent of the patients arrived directly in thePEU without passing through the General emergencydepartment of the Hospital.The attendance rate increased progressively fromOctober with a peak in February and progressivelydecreased from March to September (Figure 1). Thenumber of daily attendances increased from Mondayto Sunday according to a r of 0.59 (p

36 T. Giacaolone, M. Vanelli, C. Zinelli et alto 12 noon 22%. Attendance originating from the ethnicminorities was stable during the working days, butincreased significantly on Saturdays and Sundays(χ 2 =19.7; p

Paediatric emergency37ing-hours and prompt-availability of Family Paediatriciansduring the weekend and holiday time should bemodified according to their patients demands. A fewFamily Paediatricians in Parma have already respondedpositively to these demands by joining their consultationsin an associated bureau in order to assure their patientsa continuous availability of at least one Paediatricianduring the day, weekend excluded. A similar solutionshould be encouraged everywhere. The discussionon the probability of involving Family Paediatricians inthe functioning of a PEU as physician on call is stillunrisolved, although this solution has already been successfullyintroduced in some areas (4).All Authors agree that special attention must alsobe addressed to the users of a PEU in order to reducetheir attendance. In our experience, at least 80-90% of attendances to the PEU were “subjectiveemergencies”. This means that they could be treated athome by parents. To achieve this target in the future,a continuous health education and information programfor the general population and first-time parentshas to be planned (5). Mass-media could be useful toeducate and to accustom the general population to usethe public health services more rationally, but for firsttimeparents an important effort has to be asked forfrom both hospital nursing and medical staff duringthe pre-natal period, and Family Paediatricians afterbirth. Education programs need to be addressed particularlyto the parents of children aged below 5 yearsof age, as these resulted as being the most frequent patientsseeking consultation. Equally important is theeducation of parents on first aid training, recognitionof signs and symptoms of a serious illness or a significantinjury, and indications for seeking immediatecare. The provision of printed handouts and standardizeddiagnosis-driven discharge instructions, alongwith verbal communication during “well child” or urgentcare visits are also helpful mechanisms for informingparents which emergency situations may handledat home without attending a PEU (6).Sixteen per cent of patients of our PEU were admittedfor a short clinical observation. In 44% of themthe stay in the PEU lasted 12 to 24hours and in 30%the admission was even shorter, 2 to 12 hours. The sixbeds attached to the PEU proved very useful in maintainingpatients of dubious diagnosis under observation,giving the Paediatrician on duty the time andmeans to perform useful tests to make correct diagnosisas quickly as possible. Our experience on this subjectwas positive and proved that a PEU cannot workwithout a few beds. The availability of these beds allowedus to avoid those admissions needing less thanone or two days to diagnose and treat an acute disease,and to leave available beds for more serious patients.Without a doubt, a PEU equipped with a few beds forbrief clinical observations and provided with a specificmedical and nursing staff will result in services thatare highly effective.References1. Giovannini G, Lambertini A, Giardina A. Il Pronto Soccorsopediatrico in Italia. Riv Ital Ped (IJP) 1998; 24: 129.2. Amodio L, Tipo V, Vetrano F, Vitale A, Cardoni G, MagnaniM, Messi G. Osservazione breve in pronto soccorsopediatrico: modelli organizzativi e budget. Quaderni di Pediatria,58° Congresso nazionale italiano della Società italianadi Pediatria, Montecatini Terme 28 settembre-2 ottobre2002. Pacinieditore 2002; vol 1: 6-9.3. Messi G, Giuseppin I, Guglia E, Picciotti E, Magnani M,Cardoni G, Mazzoni N, Vetrano F, Vitale A. L’ epidemiologiadegli accessi pediatrici. Quaderni di Pediatria, 58° Congressonazionale italiano della Società italiana di Pediatria,Montecatini Terme 28 settembre-2 ottobre 2002. Pacinieditore2002; vol 1: 6-9.4. Bollettino ufficiale della Regione Autonoma Trentino-AltoAdige. Deliberazione della Giunta provinciale. 24 novembre1997, n. 6151: Approvazione dell’ accordo a livello provincialeper la disciplina dei rapporti con imedici specialisti pediatridi libera scelta.5. Monterisi N. Pronto Soccorso Pediatrico: problemi attuali.Pediatria d’ urgenza 2001; 17: 23-30.6. Brownstein DR, Rivara FP. Emergency medical services forchildren. In: Nelson textbook of pediatrics. Behram RE,Kliegman RM, Jenson HB eds, W.B. 16 th edition. Saunderscompany, Philadelphia, 2000: 237-44.7. Giardina A. Cultura pediatrica ed urgenza sanitaria … oggi.Pediatria d’urgenza 1998; 11: 7-8Received: 14 January 2003Accepted after Revision: 20 February 2003Correspondence: Prof. Maurizio VanelliChair of Paediatrics, Post-graduate Medical School of Paediatrics,Department of Paediatrics, Children’s HospitalUniversity of Parmav. le A. Gramsci, 14 - 43100 Parma, ItalyTel/Fax: +39 0521702319E-mail: vanelli@unipr.it