Is Your Hospital's Emergency Department Prepared To Treat Your Children?

Very long form story in the Wall Street Journal yesterday about children dying or severely injured after they are rushed to hospital emergency rooms which are poorly prepared to treat them.  The conclusion of the article covers an the failure to quickly X-ray a child in the St. Mary Mercy Livonia (now Trinity Health Livonia) emergency department:

https://archive.ph/XzyEI

Children Are Dying in Ill-Prepared Emergency Rooms Across America
By Liz Essley Whyte and Melanie Evans - October 1, 2023

Hundreds of children die or are left severely injured around the country each year after they are rushed to hospital emergency rooms that are poorly prepared to treat them.

Only about 14% of emergency departments nationwide have been certified as ready to treat kids, or are children’s hospitals specializing in treating young patients, The Wall Street Journal found.

Many emergency doctors don’t treat enough children to be able to spot life-threatening illnesses obscured by run-of-the-mill symptoms, or conditions more common in kids. Some E.R. staff default to drug doses and protocols meant for adults and either don’t have or don’t know where to find child-size gear in a crisis.

Doctors, health authorities and policy makers have known—and warned—of these failures for decades. Research in recent years has quantified the lack of readiness and number of child deaths that could have been avoided, and pointed to basic steps for solving the problem.

Yet most hospitals haven’t taken action, according to the Journal’s investigation of certification levels in all 50 states, reviews of medical records and interviews with doctors, health officials and researchers.

Parents in many places can’t make an informed decision about where to take a child in a medical emergency. More than 70% of emergency departments have completed a federally funded assessment gauging whether they are ready for kids, but results for individual hospitals are confidential. Meanwhile, 25 states don’t check E.R.s’ pediatric preparedness at all, and even some that do check don’t publish names of the hospitals that earned recognition for being prepared.

The Journal put together the first comprehensive list of hospitals nationwide that have received state certification of some level of readiness for pediatric emergencies, or are children’s hospitals or pediatric trauma centers expert in taking care of young patients.

The fraction of hospitals that are deemed ready have varying levels of requirements. Some haven’t done much more than identify weaknesses and promise improvements, the Journal found.

The lack of preparedness costs lives, research shows. About 1,440 children died from 2012 to 2017 because the emergency rooms that treated them weren’t well prepared, according to a study of 983 E.R.s published in January by JAMA Network Open.....

<snip>

Severe injuries

On the outskirts of Detroit, emergency staff gave 4-year-old Mason Seitllari apple juice and Tylenol after his parents brought him to an emergency room for vomiting and stomach pain.

It took four hours for the St. Mary Mercy Livonia emergency department to order an X-ray of Mason’s bowel.
A dangerously crumpled bowel is more common in kids than adults. The condition, known as intussusception, can be easily missed by emergency rooms that lack experience treating children, pediatric specialists said. It can be easily confused with constipation or a stomach bug. Yet if caught early, an enema can treat it.

This account of Mason’s treatment is based on depositions, medical records and other documents that were part of the family’s lawsuit against St. Mary Mercy and others. It is also based on interviews with Mason’s parents.

Mason’s parents, who moved to the U.S. from Albania, took him to St. Mary Mercy in April 2017 because it was close to their home in Livonia. “I thought every hospital in U.S.A. is good,” said Nisjeta Seitllari, Mason’s mother.

St. Mary Mercy, which is owned by Trinity Health, had discussed sending Mason home before it got the X-ray results. Mason was rushed to the University of Michigan Health C.S. Mott Children’s Hospital. Doctors there quickly diagnosed his intussusception.

Mason’s oxygen dropped. He went into septic shock. Doctors rushed him to emergency surgery. In the operating room, Mason’s heart stopped.

“It was a nightmare,” Nisjeta Seitllari said. “That is the worst thing that can happen to a parent.”

Mason needed about a dozen surgeries and procedures on his bowel and lungs. He spent nearly four months in the hospital. When he finally left, he had one tube in his throat to get oxygen and needed another tube through his nose for feeding.

The negligence lawsuit filed by Mason’s family is scheduled for trial in March.

The hospital and doctors denied the lawsuit’s allegations in court documents. A Trinity Health representative declined to comment, citing ongoing litigation.

Mason’s lungs suffered long-term damage. Now 10 years old, he depends on inhalers and is shaken by a device to keep his lungs clear.

He has been hospitalized several times for pneumonia, a complication from the lung damage. His parents won’t go to St. Mary Mercy, now named Trinity Health Livonia, and instead take him to Mott Children’s.

“We just don’t want to take the risks,” Nisjeta Seitllari said.

Being a child doesn't qualify as a DEI category in todays medical establishment intersectionality politics! ☹️