Safe Discharge from the Pediatric Emergency Department

Abstract

The future condition of pediatric patients discharged from the emergency department can never be guaranteed even when the diagnosis has been clearly defined. As a result we are dependent on our clinical judgement of the patient's stability as well as the understanding and capability of the parents in safely discharging pediatric patients. Up to 75% of patients/ parents do not understand the instructions given at the time of emergency department discharge and not surprisingly almost all malpractice complaints arising from the emergency department have incomplete discharge instructions as a component [1].CMS guidelines mandate discharge instructions be written in appropriate language, at no more than a 5 th -7 th grade reading level, and specifically address description of signs and symptoms associated and expected during the progression of the illness [2,3]. CMS also comments that generic discharge instructions for the emergency department as a whole do not adequately address the unique needs of pediatric emergency medicine and should be individually tailored to the pediatric patient. Below are some guidelines for safe discharge from the pediatric emergency department. Objectively assess physiologic stability by directly evaluating vital signs and clearly document this cognitive process in the medical recordNormal values are readily available in texts. Do not depend on observations by nurses and other ancillary personnel and contemplate the implications of each vital sign. This should be the culmination of a series of observations throughout the emergency department stay. Always document vital sign course, stabilization, and conclusions at the time of discharge fully. Teach parents how to measure heart rate and respiratory rate as well as acceptable values.