CHOC’s New Emergency Department is Now Open – What to Expect During Your Visit

An Emergency Department trip can be nerve-wracking and daunting – for children and parents alike. To help calm your nerves, here’s a summary of what you’ll encounter at the Julia and George Argyros Emergency Department (ED) at CHOC Children’s Hospital:

Parking

Pull into the ED driveway off Pepper Street. Valet parking is available for ED visitors: Just leave your keys with an attendant. Complimentary valet parking is available 24 hours a day, seven days a week.

Screening

Once you enter the ED lobby, a registered nurse at the screening desk will greet you and determine your reason for visiting. If there’s a wait, you will be called to the screening desk in the order of your arrival – unless your child’s condition requires immediate attention.

Registration

Next, an employee will obtain your registration information. This happens in two steps: When you arrive, the employee confirms your basic identification information. Before you leave, staff will ask for other information, such as your insurance carrier and primary doctor.

Triage

Your child will be called into a triage suite, where a nurse will ask questions, collect vital information such as temperature, pulse and weight, and perform a basic exam. During triage, the nurse assesses the child’s condition and determines the urgency of the situation and what type of care the child will need.

In most cases, children are seen by a triage nurse in the order that they arrived, but those with serious injuries or illnesses may go ahead of other patients. This is why you might notice some families being called first even if they arrived after you. If a treatment area or exam room is available upon your arrival, you will bypass the triage process entirely.

Lobby

If all treatment rooms are full following triage, you and your child will wait in the lobby. While there, please do not allow your child to eat or drink. Notify the screening nurse if the child’s condition changes or if she needs a scheduled medication. If you must leave the ED before treatment, notify an employee.

Treatment Area/Exam Room

Here is where your child will receive treatment. The ED has several types of treatment areas that are each set up to provide a specific type of care. You might notice another family called ahead of you from the lobby should a space related to that child’s needs become available.

Once inside, you will be given a hospital gown for your child. Please undress your child and place him or her in the gown as quickly as possible to avoid a delay in the exam. If you bypassed the triage process, your child will undergo a similar exam here before seeing an ED physician.

Your physician might order tests and perform treatments, which will all be carefully explained to you. The doctor will also review test results with you. The physician will also plan for follow-up care, and, if necessary, hospital admission.

Discharge

A patient is discharged once the physician gives approval for you and your family to leave. Be sure that you have a clear understanding of any instructions from your physician before you leave.
Your Emergency Department Packing List
The decision to take a sick or injured child to the ED can be abrupt, but if you have some time, consider bringing along a few items that could prove helpful during the visit:

• Diapers, formula and other baby supplies
• A list of any medicines your child takes
• Any referral paperwork, X-rays or lab results
• A blanket, stuffed animal, favorite toy or anything else that will comfort your child
• Personal necessities, such as a cellular phone charger, and change for the pay phone

Though documentation is not necessary, it’s important to know the following information when you visit the ED:

• If your child is current on his or her immunizations
• Your child’s primary physician
• Your child’s medical history

Here’s what not to bring to the ED:

• Food or drink is not allowed in the ED, and consuming anything before treatment can put a child at risk.
• If possible, try to make childcare arrangements for infant siblings during influenza season. Babies are at particular risk for contracting the flu.

Learn more about the Julia and George Argyros Emergency Department at CHOC Children’s.

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CHOC Children’s ED Strives to be ‘Ouchless’

Stitches, shots and sutures can be scary for Emergency Department patients of any age, which is why the Julia and George Argyros Emergency Department (ED) at CHOC Children’s Hospital strives to make visits as ouchless as possible.

Staff members take a holistic approach for pain management at CHOC: Not only do they focus on minimizing physical pain, but they also focus on alleviating mental discomfort. Staff members are versed in age-appropriate techniques, and also call on Child Life specialists to help or relieve fear and anxiety in patients. In line with CHOC’s mission to provide family-centered care, ED staffers also rely on the simple presence of a parent or guardian to help calm patients.

Distraction also plays a strong role in comforting patients. Here’s a short list of distraction methods or tools used in the ED:
• books
• iPad
• games
• movies
• stickers
• coloring books
• video games
• bubbles
• beads

ED staff members also have a variety of medical tools at their disposal to help ease pain and minimize discomfort during procedures. Here’s a short list:

Ultrasound-assisted blood draws

CHOC Children’s ED has a one-poke goal, meaning staff members work to ensure that a needle is injected just once during a procedure. If a patient’s veins are difficult to find, perhaps because they are dehydrated, staff may rely on an ultrasound machine to help identify the location of a vein. This increases the chances that one poke will be sufficient to achieve the procedure’s goal.

J-Tip Needle-Free Injection System

The J-Tip allows CHOC Children’s ED staff to administer numbing medication, such as lidocaine, transdermally and without needles. The device uses pressurized gas to propel medicine into the subcutaneous portion of the skin in less than a second. Once activated, the J-Tip emits a “pop” and “hiss” noise, similar to what’s heard when opening a soda can. The J-Tip is easy to use for staff and virtually painless for patients.

Toot Sweet

Efforts to minimize discomfort are made for even the smallest of patients at CHOC Children’s ED. Staff members offer babies pacifiers dipped in Toot Sweet, a 24-percent water and sucrose solution. Absorbed through the mucous membranes in the mouth, the solution has proven to calm and soothe infants. The solution can be administered just minutes before a procedure, or during as necessary.

LET

Patients receiving stitches at CHOC Children’s ED hardly feel a thing thanks to LET, a topical anesthesia mixture containing lidocaine, epinephrine and tetracaine. A staff member will apply the numbing gel to the affected area before administering stitches. The affected area will feel numb and weak, which usually wears off after 20 minutes or so.

LMX

CHOC ED patients who will undergo a lumbar puncture or who have ports that must be accessed will first be numbed with LMX, a topical liposomal lidocaine cream. It takes between 20 and 30 minutes to take effect, and wears off between 40 and 60 minutes after application.

The Julia and George Argyros Emergency Department at CHOC Children’s is located at 1201 W. La Veta Ave., Orange, CA 92868, in the Bill Holmes Tower. 

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Dignity, Respect Run in This Nurse’s Family

Not a day goes by that we at CHOC Children’s don’t consider the great impact of nurses – but this week, Nurses Week,  presents us with a formal occasion to celebrate our nursing staff.

In today’s blog post, we hear how Julia Afrasiabi, an Emergency Department charge nurse, is making futures bright for the children of Orange County, and her personal connection to nursing.

When it comes to Julia Afrasiabi’s bedside manner, the charge nurse in the Julia and George Argyros Emergency Department at CHOC Children’s Hospital takes a cue from mom.

“My mom’s a pediatric hospice nurse,” Julia says. “Her big things are dignity and respect – she always taught me that.”

Though a hospice nurse – who works to ensure children with terminal illnesses live their final days comfortable and surrounded by love – performs different duties than an Emergency Department (ED) nurse, Julia draws constant inspiration from her mother.

“I see my mom’s compassion for parents of dying children, so I ask myself how I could not give the same compassion to parents of children I see,” Julia says.

Julia didn’t always want to follow in her mother’s nursing footsteps; at first, she dreamed of being an interior decorator.

After deciding to be a nurse, her pediatrics specialty was hard-earned. As a nursing student, Julia experienced a personal loss of a child in her life. The painful event left Julia unsure if she could work in a setting where the death of a child was a possibility.

But once again, her mother had good advice. “She told me that personal experiences make you better,” Julia says.

And Julia’s next rotation at school sealed the deal: pediatrics.

“I loved that children were so bright,” she recalls. “Even during the worst of situations, they are happy. I love that.”

When Julia’s mother visits CHOC, the duo will meet for lunch, where there is no shortage of conversation fodder.

“There’s an interesting juxtaposition between our jobs,” Julia says. “The ED is about saving and prolonging life; my mom’s job is about the end of life. It leads to some interesting philosophical discussions.”

Unfortunately, tragedy can make Julia’s work more closely resemble her mother’s. During those difficult times especially, she channels mom.

“In the ED, I can bring healing hands,” Julia says. “But when we can’t heal, my presence can be a calming and peaceful time in a patient’s life.”

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Orange County’s Only ER Just for Kids

The Julia and George Argyros Emergency Department at CHOC Children’s Hospital is Orange County’s first all-pediatric emergency department. But did you know that children don’t have to appear seriously ill in order to come here for evaluation and treatment?

That’s because children often have quite different symptoms than adults. A high fever, stomachache or other mysterious aches and pains that would not to appear be serious in an adult can, in fact, be dire for children. When in doubt, it’s always best to let the experts decide. And no one knows more about babies, kids and teens than the pediatric professionals at CHOC Children’s. 

We sat down with James Pierog, M.D., medical director of CHOC emergency medical services, to find out what else parents should know about CHOC’s emergency department. 

Q. Okay, so how do I know if I should take my child to the emergency department?

Dr. Pierog: Always trust your gut. We treat a variety of ailments, big and small, from broken bones and small abrasions, to fevers and headaches. No matter is too small, and no patient is turned away. Even if your child does not need treatment, you’ll leave our emergency department with reassurance and education.

Q. What is so different about CHOC’s emergency department? Why do kids need a special place?

Dr. Pierog: It is the only emergency department in Orange County that has been designed, equipped and staffed with an all-pediatric focus. Children are not miniature adults, and it’s not simply a matter of ordering smaller blood pressure cuffs. Children and teens are physiologically different than adults. Our pediatric physicians, nurses and staff members know how to treat their unique medical needs.

We also offer services you won’t find at regular hospitals, like child life specialists. These trained child development professionals are experts at providing comfort to patients and families. They can help explain procedures or ailments in a way that is easy for children – and their parents — to understand. They also provide distractions to help alleviate pain, minimize anxiety or pass the time.

Q. Can I stay with my child?

Dr. Pierog: Absolutely. In fact, our exam rooms are larger to accommodate family members, including younger siblings and their strollers. A parent’s presence is the best coping mechanism around, and siblings also have a role in treatment and healing. Just keep in mind that a visit may take awhile, and small children may grow inpatient.

Q. Will the wait be long?

Dr. Pierog: Our emergency department is designed for fast triage, rapid diagnosis and speedy treatment to streamline each visit. Still, it is hard to estimate how long a visit will take. It will depend on the type and severity of your child’s ailment, as well as other patients visiting the ED that day. We usually see patients in order of their arrival, but children with serious illnesses or injuries may be seen first.

Q. I have an HMO: Do I need to get approval before coming to CHOC?

Dr. Pierog: CHOC does not require approval from a patient’s healthcare provider to offer care at the Julia and George Argyros Emergency Department. However, you should check with your provider for more details regarding coverage specifics.

What To Bring With You
• Diapers, formula and other baby supplies
• A list of any medications your child takes
• Referral paperwork, X-rays or lab results, if available
• Blanket, stuffed animal, favorite toy or other comfort item
• Cell phone and charger, or change for the pay phone.

Learn more about the Julia and George Argyros Emergency Department at CHOC Children’s Hospital.

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