Emergency care

Triage

Upon your arrival in the Emergency Department, you will be welcomed by a triage nurse, whose responsibility is to prioritize care for patients. The Emergency Department does not function on a first come first serve basis. Policy is that the sickest patients are seen first. Triage is a dynamic process.

The process of triage is one of sorting and involves the assessment of patients through a brief interview to obtain a history, and perform a brief physical assessment. The pediatric assessment triage includes assessment of the child/youth's appearance, work of breathing, circulation and mental health status.

Triaging involves communication with patients/families regarding priority of care and treatment, notifying patients of potential delays, reassessing waiting patients, and instructing patients and families to notify the triage nurse if there is any change in the child/youth's condition. It is important to note that waiting times will vary and the staff is not able to provide you with a time frame of how long you will wait as there are many variables that may occur without advanced warning. Please appreciate that they continuously evaluate the status of patients and availability of staff and always try to provide the best and earlier care possible.

Reference: Canadian Pediatric Triangle and Acuity Scale, Implementation Guidelines for Emergency Departments, Canadian Journal of Emergency Medicine, October 2001. Vol. 3 No. 4

Registration

After triage, you usually go to the registration area. The clerk will ask you questions, such as your address, your telephone number and the name of your family physician. It is important to give complete information. You will be asked for your Ontario or Quebec health insurance card, or other health insurance information if you are visiting from another jurisdiction.

Waiting room

You will be asked to wait in the waiting room if an exam room is not available. The triage nurse may recommend that you not to give your child anything to eat or drink while waiting, if it is believed some specific tests will be involved. Please follow these instructions.

The length of time your child's wait depends on several factors, including the significance of the illness or injury, availability of medical and nursing staff, availability of treatment room, and acuity and/or volume of patients in the department.

There are several areas where you may be directed to wait, including the main waiting room, an acute care treatment room, an isolation room, and the ambulatory zone (AZ).

Usually, the ED is busiest during the evening hours. Please be aware that even though the department might appear quiet, there could be very sick children being cared for in acute care rooms.

CHEO has been making great progress reducing its wait times to some of the best in the province.

Ambulatory zone (AZ zone)

This is a special area for those patients who are less sick or with minor injuries. By separating the less sick from the sicker, CHEO is able to see all patients more quickly than ever before. The AZ is staffed by emergency physicians, nurse practitioners and registered nurses.

Exam room

As soon as possible, you and your child will be brought to an exam room where a team of doctors and nurses will care for your child. If your child needs blood tests, X-rays or other tests, it may take an hour or more to get the results. Please be patient. You may be asked to return to the waiting room during this time.

A parent or guardian must stay with his or her child at all times.

Going home

If needed, you'll be given printed instructions once your child is ready to leave. These instructions have information on how to care for your child's illness or injury and will tell you about follow-up care. We send a copy of the record from the visit to your child's primary care provider to explain to the provider what was done for your child and what was recommended.

We ask that you do not call the Emergency Department for your child's test results.

CHEO has specially trained nurses who will follow up with you if it is required for such items as:

• abnormal laboratory results
• some X-ray reports
• other follow ups with specialty clinics both within and outside of CHEO

Registered nurse

A triage nurse assesses your child on arrival and prioritizes the care. The ED nurses provide nursing care for a variety of patients from those with minor medical problems to emergency resuscitation cases.

Emergency room physician

Provides medical assessment and directs treatment for all children, and youth who present to the department. They also receive referrals and provide advice to physicians in other hospitals, clinics and doctor's offices.

Nursing students

As a teaching hospital, CHEO provides educational opportunities to nursing students from university and college programs working with ED nurses to develop and enhance their pediatric skills and knowledge. This enables them to fulfil the pediatric clinical component of their educational programs.

Health care aids

Specially trained personnel who assist the medical/nursing team in many aspects of their day's activities, such as wheelchair rides, a stretcher ride, or helping to hold and calm your child still while a procedure is being performed.

Emergency fellows

Are physicians who are specializing in pediatric emergency medicine.

Emergency residents

Are focusing on caring for patients in the Emergency Department, as part of their medical training program.

Medical students

Are beginning their study in medicine and have been provided dedicated clinical time in the ED.

Nurse practitioner

The nurse practitioner is a registered nurse with advanced knowledge, training and health care management skills. In collaboration with the physician, the nurse practitioner in the ED provides health assessment and treatment to children and youth with minor illness/injury. The nurse also follows up the results of tests and X-rays once the patients have been discharged.

Child life specialists

Provide opportunities for procedural support and preparation for medical interventions through diversion and play. They also provide emotional support to children and their parents while encountering difficult experiences such as trauma and/or hospitalization.

Social worker

For emotional support and care, an emergency Social worker may be asked to meet with a patient/family in the ED. In a time of crisis, the Social worker is able to assist in the provision of support and helpful resources within the hospital as well as the community.

Crisis intervention social worker

Specialized social workers will provide assessments of children and youth who present with mental health concerns. In addition, recommendations for appropriate follow-up will be addressed.

Other personnel

Other personnel you may meet include a Spiritual advisor and Cultural interpreter who may provide language or sign interpretation, and other students from various programs such as military personnel and paramedicine.

What do I do when my child is sick?

The following are suggestions which may help you decide how to manage your child/youth's illness:

First decision: Do I consider this health concern severe, moderate or mild?

Severe

If this is an emergency (i.e. severe difficulty breathing) call 911.

Moderate

If child is looking unwell and I am concerned. My options are: to phone my family doctor or pediatrician, phone Telehealth or CLSC (Quebec). Is this requiring a visit to the Emergency Department or a community clinic? Do I need to call an ambulance or will I drive to the hospital?

Mild

Is this something I can manage at home on my own? (i.e. simple cold with no change in condition) Phone my family doctor or pediatrician, phone Telehealth (Ontario) or CLSC (Quebec) for advice.

I want to bring my child but I don't have their health card in my possession — what do I do?

Go to the Emergency Department. We will look after your child and the health card issue will be resolved once your child has been cared for.

We live in Quebec, can my child still be seen at CHEO emergency?

Yes. In the event of an emergency, any infant/child/youth can be seen, regardless of where they are from.

When should I worry about a fever?

You'll need to come to the emergency department if your child is:

• under 3 months and has a fever
• is very irritable or sleepy and doesn't improve with fever medication
• has trouble breathing
• has signs of dehydration, like dry mouth or is not peeing for at least 8 hours.
• has a headache or sore neck that does not go away with fever or pain medication.

You'll need to see your family doctor when your child:

• has a fever for more than four days
• is not getting better after one week of symptoms
• develops an ear ache

How long is the wait in the Emergency Department?

Nursing staff can provide rough estimates about waiting times, but please keep in mind that in the ED, the “first come, first served” rule does not necessarily apply. Urgent Cases, involving critically ill or injured children / youth (e.g. motor vehicle traumas, severe asthmatics, to name a few) take priority. Please be patient and you will be seen as soon as possible. Please notify an ED nurse if you feel your child/youth's condition has deteriorated while you have been waiting.

Can I give Tylenol and Advil together?

Try ibuprofen first, and then acetaminophen if the ibuprofen does not help. Ibuprofen and acetaminophen can make your child more comfortable by bringing down the fever a little. Most children will not need to have both medications.

When your child has a fever:

• try ibuprofen first, as it works better for most children
• if your child does not improve one hour after ibuprofen, you can try acetaminophen
• if your child has a fever due to chickenpox, use acetaminophen instead of ibuprofen 
• do not use aspirin

Can I give my child their puffer more than every 4 hours:

Visit the Childhood Asthma website.

My child is being treated for an ear infection and I think my second child has one too — can I give my second child the antibiotic that has been subscribed to my first child with the infection?

No, never give or share a prescription medication that is not specifically prescribed to your infant/child/youth. See your physician.

How do you know when to come to the Emergency Department?

See CHEO's "Deciding to come to the Emergency Department" pamphlet.

My child who has diabetes has a fever and is vomiting. Who can I call?

For CHEO diabetes patients there is a 24 hour Hotline number: 613-737-7600, press 0 immediately to reach the operator.

The on-call diabetes physician is available for urgent medical advice (for example illness, insulin errors, severe hypoglycemia). Note: this is not for routine insulin adjustments.

If your child is not a CHEO diabetes patient, you can call your child's physician or Telehealth Ontario (1-866-797-0000).

Telehealth Ontario is a free, confidential telephone service you can call to get health advice or general health information from a registered nurse 24 hours a day, 7 days a week. Visit the Telehealth Ontario website.

I have a newborn baby. Where can I get information about the "normal" things I should expect?

Following birth there are normal changes that your baby goes through, which may cause you concern. There are community resources which can help you in understanding your newborn's growth and development and which you can go to for information. You should address any immediate health concerns with your family doctor or pediatrician, who would be happy to answer any of your questions as well.

In Ontario, each city has a Health Department with a Public Health Nurse visiting program. In Ottawa it's known as the Healthy Baby Healthy Children's program and is located at 100 Constellation Cr. You may contact Ottawa Health Information at 613-580-6744; Toll free: 1-866-426-8885 or TTY: 613-580-9656 (text telephone for the hearing impaired) for more information. You may also contact Ottawa People Services at 613-580-6744 for more information. The La Leche League of Canada is a mother-to-mother network with over 40 years of history of practical breastfeeding and mothering wisdom. They can be reached at 613-238-5919. These programs provide resources, education and support for parents with respect to general baby care, safety and breastfeeding issues.

Where can I access emergency dental services for my child?

Emergency dental treatment may be rendered to a patient through CHEO's Dental clinic, during regular working hours of 8:45 a.m. to 4:30 p.m. After hours emergencies need to be assessed in the ED by an emergency physician who will determine whether a dentist needs to be called. There is also a 24-hour dental emergency number which you can call at 613-523-4185. In general, dental services are not covered by OHIP.

Where can I get health advice regarding pediatric illness?

Visit the Telehealth Ontario website or call them at 1-866-797-0000. This is a 24-hour service provided to residents of Ontario. A registered nurse can answer your questions and direct you to appropriate resources. The Health Department also known as the City of Ottawa People Services has a Parent-Child Info Line which can be reached at 613-580-6744 extension 28020 and is operated to service the public from Monday to Friday from 9:00 am to 4:00 pm. This is a telephone health counseling service where you can obtain information about any health-related issue regarding adults and children from a Registered Nurse. You can call and get advice on such topics as:

• general health: adult/children
• speech and language concerns with your preschooler
• nutrition and healthy lifestyles
• smoking cessation
• injury prevention (such as car seat safety)
• prenatal classes

For Quebec residents there is the CLSC which can be reached at 8-1-1. Listen to the complete message for after hours services.