New lab test protocol improves safety for kids in Surrey’s Pediatric Emergency

Imagine, for a moment, a very sick child who arrives at Emergency in need of urgent care. The healthcare team does what they can to keep the child safe and comfortable as they anxiously await the lab test results – a critical step in determining the most appropriate treatment and intervention – but the results don’t come as expected, and the child continues to deteriorate.

This happened to a child in Surrey Memorial Hospital’s Pediatric Emergency. Fortunately, the child was ok and appropriate care was provided in time, but the event was a signal to the staff that something had to change to prevent a similar situation from happening again. 

“All of us were quite upset over this and we were eager to find a solution,” says Joanne Shum, Director of Pediatrics, Fraser Health.

Within 24 hours, a multi-disciplinary team meeting was held to review the event (in BC PSLS) and discuss what happened. 

By the next day, the new Trauma Room Rapid Metabolic Profile Protocol was put in place.

Cindy Benes, Laboratory Manager, says, “We’ve been using a similar rapid lab test protocol for adult emergency for years – it’s been very successful and staff know it well. We all agreed the protocol could be safely used for our Pediatric Emergency. We made some modifications to it to make sure it would be suitable for children, but we didn’t want to waste any time setting this up – we just did it,” she says.

Today, when a child comes to Surrey’s Pediatric Emergency and STAT lab test results are needed, a “pink” Trauma Room Rapid Laboratory Testing Requisition is sent to the lab, along with the child’s blood sample, and results are given to the Patient Care Coordinator within 3 to 5 minutes.

Ron Bate, Interim Program Manager, Pediatric Emergency, says the new lab protocol has improved the way trauma cases are managed at the hospital. “Now we can communicate our needs to the lab more clearly and efficiently, and that’s really important for us because we’ve faced some very unique challenges since opening our doors two years ago.”

Ron says Surrey’s Pediatric Emergency has experienced close to 100% growth in the number of patients who come in for treatment. “People know we’re here now and they’re coming, not just from Surrey, but from Langley, Richmond, Delta and Abbotsford. We might see 60 kids a day – last year during Christmas we had 156 kids in one day. That’s not something you can predict, but we’re adapting and coming up with strategies to meet the needs of the population we serve.”

Part of their plans include a more streamlined registration and triage process so incoming patients can be assessed and treated faster. And they’re hopeful that the purchase of two more “fast track” beds will be approved so patients will be more comfortable while they wait to see a physician. In addition, some of the nurses are advancing their skills in pediatric emergency care by taking the new Pediatric Nursing Specialty program at BCIT that was developed with input from SMH’s Pediatric Emergency and BC Children’s Hospital.

“It’s more out of necessity than anything – there’s certainly areas where we can improve, but we have trended below .5% for time to be seen by a physician and I’m proud that we can provide that level of care to our patients.”

 

 

 

Two projects have led to a reduction in medication errors across Fraser Health: (1) the implementation of a pre-printed order form for “pain” so staff knows right away what quantity of acetaminophen to give a patient, and (2) a new “quiet time” routine so nurses can focus on giving medications to patients without external distractions such as noise or other interruptions.

“We’re a very adaptive team at SMH,” says Cindy. “We don’t really have the luxury of sitting back and waiting because we’re continuously growing. This particular case was very direct communication amongst all the areas involved – we just did what we needed to do.”

Congratulations to SMH’s Pediatric Emergency and Laboratory!