Safe & Calm
An innovative program makes time in the hospital less scary for kids.
CATHY TAYLOR AND Michelle Tracy had never met, but the two Marin moms had something in common: they’d both suffered through upsetting hospital visits with their children that inspired them to make emergency room care work better for families.
Taylor, a sonographer at University of California–San Francisco Medical Center who lives in Greenbrae, brought her then-3-year-old to Marin General in an ambulance with complications from croup. She was dismayed that when her son cried for his daddy, he couldn’t see him, because a flu-season one-visitor policy relegated Dad to the waiting room.
Tracy, who lives in Corte Madera and manages Marin General’s emergency and trauma departments, had an experience no parent ever wants to face: after a car accident, she was prevented from seeing her critically injured 4-year-old. “When your child is in a critical accident and she may not make it through the night, her mother should be by her side. And that wasn’t allowed,” she says. Initially she was even denied information about whether her daughter had survived. “The physician told me, ‘if you don’t calm down, I’m not telling you anything about your daughter,’ ” she recalls.
Both children recovered, although Tracy’s now-adult daughter faces lifelong challenges due to traumatic brain injury. But neither mother was prepared to merely complain to management and move on.
Months before her distressing visit to Marin General, Taylor had encountered a completely different style of care when her son got hurt at Disney World and received stitches at Orlando’s Arnold Palmer Hospital for Children. A child life specialist (a professional who helps kids and parents cope with treatment) advised Taylor on how to keep her son calm and offered an iPad to distract him. A nurse applied a numbing gel so the toddler didn’t have to have a shot.
“He lay there with his chin up, staring at the iPad, with no sedation, and let that doctor stitch him up,” Taylor says. “He was scared, but he was calm.”
So when she had a bad experience at Marin General — beyond the one-visitor policy, Taylor was disturbed to hear staff yelling and failing to provide a supportive environment for a scared child — she wondered if she could convince those in charge at Marin General to make it more like Arnold Palmer.
The more Taylor looked into the issue, the more she realized how high the stakes were. One in five Marin residents is a child. How would Marin General, the county’s only trauma center, handle a f lood of injured children in an earthquake?
Taylor spent six months attending Marin Healthcare District meetings and researching what’s known as “ouchless emergency care” for children — care that takes children’s needs and fears into account, while minimizing pain. When she finally spoke up, Marin General management connected her with Tracy, then the assistant vice president of nursing, who had long wanted to advance such an approach.
“We had always had other pressing initiatives here. But Cathy really helped make this a priority,” Tracy says.
With Tracy working from within and Taylor reaching out to patient communities, fire chiefs and experts, the pair has achieved much. Now Marin General’s ER is an ouchless emergency department, using the same distraction techniques and kid-friendly equipment that Taylor saw in Orlando.
Perhaps most important is the training staff received, funded by a $30,000 donation from the Schultz Family Foundation. Doctors, nurses and technicians all attended a symposium taught by experts including a pediatric pain management doctor and child life specialists from UCSF Benioff Children’s Hospital in San Francisco. The staff learned what medications can be administered via mist instead of needles, and they role-played to practice soothing anxious parents and children. Nurses have parents hug a child getting a procedure to help them stay still, for example, instead of restraining the child on a table.
“How traumatic the experience is can be completely controlled by a little effort from staff,” Taylor says.
Now that the Ouchless ER is up and running, the two moms aren’t resting on their laurels. Tracy is overseeing a new, more ambitious initiative at Marin General: seeking certification as an Emergency Department Approved for Pediatrics.
“What that means is that we are not just a hospital that takes care of kids. We are a hospital that gives as good [a level] of care to children as a children’s hospital would give, minus all the [pediatric] specialists,” Tracy explains. As part of that effort, the hospital has earmarked $160,000 to have all nurses certified in pediatrics and to hire a child life specialist. And when it’s built, Marin General’s new emergency department will cater to kids with private pediatric rooms and a separate waiting area that should shield kids from witnessing scary things adult patients might be going through.
Meanwhile, Taylor is looking to help other community hospitals throughout California follow Marin General’s lead. Ouchless care tends to be found in children’s hospitals, but, she learned, 90 percent of pediatric emergencies are treated in community hospitals like Marin General.
“So by changing the atmosphere there, we impact nine out of 10 kids,” she says.
Although Tracy has her hands full at Marin General, she plans to continue the partnership by supporting Taylor’s statewide mission. “We want to bring this concept to other ERs,” she says. “This is something we want to share.”