Home Away From Medical Home

By now, most of you guys know that my doctor gig is as a pediatric emergency physician. That means that I’m a pediatrician and an emergency medicine physician who specializes in children.  I get to cross several different specialties, and as such I’ve had the privilege of working in the urgent care, general pediatrics, and emergency department settings.  Each of these places has something different and valuable to add to the medical care of children.  Awesome, right—

Maybe you’re thinking, “Where on earth is she going with this?”

If so, stay with me…

So I opened up my email bright and early this morning and there was a link to the newly published American Academy of Pediatrics’ policy statement on urgent care, titled Nonemergency Acute Care: When It’s Not the Medical Home. I read it with interest and realized that thus far in my year+ journey on this here blog, I haven’t really addressed a topic that I think is incredibly important and that I hold very close to my heart, and that is specialized pediatric acute care. Reading this policy statement today is my inspiration to tell you why I think it’s so important.

“Children deserve high-quality, appropriate, and safe acute care services wherever they access the health care system.”

This quote from the AAP policy statement couldn’t be more true.  Let’s first make sure we’re all clear on the different types of acute care services.

EMERGENCY CARE

Some acute medical problems can be easily addressed at your child’s pediatrician office, but not all of them, and not at all hours of the day. I’m going to assume that we all know what an Emergency Department is. I hope that many people know that there are emergency departments that are designed exclusively for children: sometimes they are their own place as part of a children’s hospital and sometimes they are part of a larger emergency department that sees adults too. The type of situations that definitely need to go there fit into the category of what one of my favorite friends and colleagues calls “OMG medicine.” Examples are big trauma, major difficulty breathing, complex medical care, that kind of stuff.

What “Emergency Care” can look like. This picture was taken during an ED training for offloading pediatric trauma patients off the helicopter – I’m off to the right.

URGENT CARE & RETAIL CLINICS

Then there are urgent care centers and retail based medical clinics. These are sprouting up in everyone’s neighborhood.  Do you know the difference between these places?  A retail clinic is one that you could find inside a retail store, like a pharmacy or a supermarket. They can provide preventative health services, like screenings and flu shots, and treat minor, uncomplicated illnesses. Urgent care offices (full disclosure: like PM Pediatrics, where I practice) typically provide a higher level of care than retail-based medical clinics. Urgent care offices have capabilities like xrays and stitches, with some places also providing IV fluids. More and more people are starting to use these locations for medical care because they are open at convenient hours and typically have quicker throughput and are less expensive than emergency departments.  Nearly all claim to see patients of all ages, but relatively few are pediatric-focused.

This is from a photo shoot at PM Pediatrics demonstrating some of the higher acuity care we can handle at our pediatric urgent care

Sounds all okay, right?  Except it’s not always.  Here’s where the child advocate in me pipes up. See, clinicians with pediatric expertise have different training than others, and as such, approach treating an acutely ill or injured child differently.  It may mean that we order more or fewer tests (see last week’s blog).  It may mean that we are trained to pay more attention to certain aspects of a child’s physical exam.  It may mean that we work in a more child focused health care setting.  Regardless, in accordance with the new AAP policy guideline on nonemergency acute care for children, the big takeaway message is that, on the whole, the best place for children to get acute care is either at their medical home by their individual pediatrician or at a place specifically set up for the best practices to treat children.

I’m not trying to throw shade on my non-pediatric trained colleagues.  Back to the top of this entry- part of my training and background (emergency medicine) is in this separate setting that is not focused on care for children.  There are doctors that span the talent spectrum everywhere.

What I do want everyone who is reading this to be aware of is that there are many differences in types of acute healthcare delivery models and that it’s important to be aware of what’s available in YOUR medical neighborhood so that you can decide what is the best option for your child; namely, a place that adheres to this AAP Guideline.

WHAT YOU CAN DO:

-Find out how many and what kinds of acute care places are near you and what their hours are.

-Talk to your child’s pediatrician about where (s)he recommends that you go if the hours or the situation calls for healthcare elsewhere.

-Determine the capabilities and staff training/backgrounds of different acute care offices near you.  Is there a pediatric focus? Just because a sign says “kids” does not always mean there is a pediatric focus. Be sure to ask specifically if they have a pediatrician on staff.

If you get the skinny on various acute and urgent care locations near you BEFORE an actual urgent care situation arises then you AND your child will know where to go, have a better experience while there, and hopefully the best possible outcome.

My dad likes to talk about the 5Rs of healthcare:

The Right care

At the Right time

In the Right place

By the Right person

For the Right price

If you do a little bit of homework for your child on this, you’ll do it just RIGHT.

Feelin’ academic? Here’s a link to the full guideline.

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