To think drunk teen shouldn't be in paeds A&E?

[Us3r21422]

NC for this in case picked up by the likes the of Daily Fail etc.

Took DD to paeds A&E last night due to concerns about dehydration after 5 days of gastro bug and decreasing tolerance for fluids and no wet nappy for 12 hours. Luckily she is OK and we were allowed home after some anti sickness meant she could tolerate water, but the place was full of really sick babies and toddlers. Dr said 4 cases of D&V/dehydration, plus a query sepsis child, croup etc.

I heard someone approach the nurses station and say they were bringing a drunk 15 year old and his parents round from adult A&E, no particular reason given, so assume this was purely based on his age. He did say dad was struggling to manage said drunk teen.

At this point I knew we were going home, so no real skin in the game, but I thought to myself that if the teen was that drunk, was paeds A&E really the place to bring him when he would have received presumably the same medical care in adult A&E?

As I say, no big deal to me as we were leaving, but I'm not sure I'd have been happy with a drunk/loud/aggressive/silly teen in the cubicle next to us. More so for the other parents and children who were really very very poorly and had clearly been there a long time, were very tired, waiting for a bed on the ward etc.

So - aibu to think drunk teen probably should have stayed in adult A&E and that it's not really desirable for a 15 year old who's had a few too many to be in the same (very small) department as lots of really unwell younger children?

Paediatric services serve up to 16, sometimes 18. It’s a funding and service provision call.

A drunk 15 year old in adult A&E would be alongside drunk 60 year olds, I’m sure you wouldn’t want your 15 year old vulnerable child in that position.

I’m an adult ICU nurse, intoxication leading to neurological compromise is one of our most common reasons for admission.

Be rest assured that if the medics felt the child should be cared for under adult services that they would be. We had a 40 year old transferred from paediatric A&E - he collapsed outside it. The nhs duty of care and the clinical needs come first, as opposed to who you consider worthy of child services and who should go to A&E.

A 15 year old intoxicated patient is a safeguarding issue, childrens safeguarding.

I hope your child is okay and on the road to recovery.

YANBU to be annoyed

YABU to expect them to do anything differently

NRTFT, but DD was under paediatrics until she was 18. Not that she could ever get drunk.

However, as a teenager, on the ward, she was often in the bed next to another teenager, who was there for attempted suicide. I remember one, who had drunk the best part of a bottle of vodka. From what we heard, they were either in care or sofa surfing, because a parent had thrown them out.

As a bystander OP, you probably couldn’t know, if they had taken anything else, which might need medical attention from paediatricians?

How you feel about it, and what the medical staff said (which surely can't be true as nurses are all angels sent from heaven aren't they??) is irrelevant.

He's a child so he's got every right to be there.

I've been thinking about this, where I used to live in a big city we had paeds a&e in the local hospital. Where I live now, Devon, our local hospital just has A&E, children are cared for by the same nurses, doctors and HCAs as the adults. Does that mean the children aren't getting appropriate treatment? If they need to be admitted they obviously go onto a paeds ward but I've definitely spent time sitting in A&E with a child, my own or my GC, and I've never considered that the people caring for them might not be properly trained in the care of children, particularly when it is a very young child.

@ancientgran thats strange I’m a paeds a&e nurse in Devon and all 4 a&es have paeds nurses working. Doctors and HCAs do see patients across all ages but due to the number of children seen by the departments there has to be a paeds nurse available

Where I am there was no designated area for children and the nurses, on two occasions that I clearly remember, were moving between adults and children. I suppose they might have been paeds nurses, would they also look after adults? So does it matter if it isn't a paeds doctor? People have been saying the 15 year old needed to be on paeds as doctors would be specialists but you say the doctors see across all ages. It seems a bit confusing. In my old city I would go to A&E in the children's hospital so obviously no confusion there.

On one occasion a doctor had to be called from a specialist ward for one of my children, but again that wasn't a paeds ward it was specialist for the condition not the age if you see what I mean. After a car accident one of my children was completely misdiagnosed, we were recalled 2 days later when the xrays were checked and that was potentially quite a serious mistake according to the Consultant (reluctantly when he was pushed) and the outcome wasn't 100%, I wonder if it would have been different if it had been a paeds doctor.

With my GS he was seen on the general A&E but then a doctor was called down from the paeds ward. I can't remember much about the nurse in A&E.

I’m guessing you must be Barnstaple area. Exeter is having a new paeds Ed area built currently. No specialist a&e paeds doctors in Devon (that I’m aware of) some have an interest or have spent time in paeds. Equally most paeds doctors aren’t routinely looking at X-rays so wouldn’t be experts. To become a specialty a&e doctor you have to have seen a certain number and spent time with paeds also take lots of exams. Exeter and Barnstaple have mixed areas and there’s a paeds nurse available They might be the one looking after your child and adults or it might be an adult nirse with a paeds nurse available for concerns.
I wouldn’t be too certain that a childrens hospital a&e is fully staffed by paediatrician emergency care doctors. That’s qualifying in 2 specialty areas. Many are a&e docs with paeds interest and lots of experience but not necessarily full paediatricians.

@ancientgran All X-rays are reviewed by a radiologist/reporting radiographer or sent to trauma triage and looked at by orthopaedics they might catch something that the original clinician didn’t it’s a good safety measure. X-rays can be tricky and even experienced clinicians can miss a fracture

@Wishiwasatailor I think the issue with the fracture was two fold, a. they missed it completely and b. it was touching and potentially partly in the growth plate so potential issues with that. I suppose if they missed it they wouldn't have worried about the growth plate anyway but I wondered if a paeds doctor would have been more onto that. Too late now anyway.

You are right about the radiologist, thinking aboutit it was the radiologist's secretary who phoned us and said we needed to come back, this was 48 hrs later and they could see us the next day so 72 hrs later.

So if all A&E doctors will have experience with paeds does that mean it is safe to treat a child in a general/adult A&E?

Of course I should add my kids are adults now so everything might be different anyway. The issue with the fracture haunts me because I believed the doctor not my child.

Thanks for your explanations, I've bottled this up for over 20 years, I think letting it out is probably a good idea.

@ancientgran a growth plate essentially looks like a massive fracture its usually much harder to spot a fracture that is close to the growth plate. It’s easy to miss. A paediatrician does not look at bone X-rays routinely generally wouldn’t have a clue how to treat any fracture but the most simplest (unless they had an interest), you need to be looking at them regularly to pick up sometimes very subtle lines.
a&e doc do this daily. Radiologists spend their careers looking at nothing but images on higher resolution screens in the dark and quiet. I’d rather my kids X-ray was looked at by an a&e doc then checked by the radiologist than a paediatrician.

Kids have much better experiences and outcomes from being treated in an environment that is catered to their needs and developmental stage so whilst they get the same medical staff and treatment the environment and nursing is much more focused on the child as a whole and is much more child friendly. Royal college of paediatrics have a document that lays out the standards for children receiving emergency care www.rcpch.ac.uk/resources/facing-future-standards-children-young-people-emergency-care-settings

@Wishiwasatailor Am I understanding this properly, a paediatric A&E is better for the child's experience but the medical care, like diagnosing the growth plate fracture is equally good with a good A&E doctor paediatric or not?

I guess if that is right I can at least feel like the longer term issues could be the same even if we had a specialised paediatric A&E. In that particular case I would say the doctor would never have got a job with paeds, he wasn't very good with children, with the other issue the doctor who came down from a ward dealing with specific problems was very good at dealing with children although his speciality probably meant he worked more with adults.

Thanks again.

Wouldn’t be safe on a safe guarding level or with mental health. No way would I have wanted my daughter treated in adult A&E when she had her overdose. In our A&Es you are triaged together and then children up until 18 are treated elsewhere. Why on earth would you want to go backwards to how things were years ago?

It isn't years ago in some places, a&e is all ages where I am.

To be clear I never felt my child was at risk from adult patients in A&E, I was with her all the time. There were a few who appeared to maybe have had too much to drink or something but they weren't threatening and I'm sure they would have been watched if they were a danger.

Well we feel very differently and thankfully those working in the system making decisions see the importance of children’s A&E services.

@ancientgran would you rather an a&e doc in paeds with 1 years experience or a a&e doc in mixed Ed with 20 years experience? What if the paeds doc hadn’t slept properly the last 2 nights because their baby had been awake all night and it was their 3rd long day? Or what if their computer screen wasn’t the greatest resolution? It’s impossible to say if outcomes might be different if you were seen elsewhere. All clinicians may miss a fracture as I say they can be extremely subtle.

In adults the nurse could have 8pts they have to go get meds transfer patients to other areas, the hca might be doing personal care behind a curtain another hca is chaperoning for a procedure. You can’t watch all the patients all the time. You don’t necessarily know who is a risk. It’s much better for kids to be in their own area

Why don't we have separate A&E for children everywhere? If it is so important shouldn't all children get that same standard. If people are right, and you seem to be saying they are, then why wasn't my child protected by having a paeds A&E? As I said I've never felt at risk in A&E and with visits for myself and 4 kids I spent a fair few hours there but if it is a risk shouldn't we be campaigning for equal protection for all children? This is raising all sorts of concerns.

Have a read of the document I linked to above and see if Barnstaple meets the criteria. It’s likely down to number of kids a year, physical space and funding. Perhaps now it’s been taken over things may change.

He's still a child a friend of mine her daughter took an overdose. Should she also have had to stay in A&E?

He's a child. You have no idea how drunk he was. Could be the parents were struggling to manage because he was on the verge of an alcohol induced coma. Unfortunately, severe alcohol intoxication is not that uncommon in teens and can be very dangerous. Let the medical team do their job and manage this vulnerable child.

Absolutely this!

15 seemed incomprehensibly old when my DC were babies. It now seems terribly young.