A trip to the E
A big part of caring for children in the ED is knowing when to prescribe medications — and when not to. Our board-certified pediatric experts understand that when it comes to using prescription medicines, children are not simply little adults. You’ve probably heard stories in the news about increasing resistance to antibiotics. Children are especially at risk for resistance. There are also risks when these medicines are given and they’re not needed. For example, antibiotics won’t cure a viral illness, so prescribing them adds risks without any benefits for your child. At Nemours, we use best practices to determine when to prescribe medicines to look out for your child’s immediate and long-term safety.
Why Measuring Results Matters
To provide pediatric care that's among the safest and most caring, we measure our results and compare them to national pediatric rates. Why? So we can:
- help you make decisions about your child’s care
- be clear about our results
- improve and consistently deliver better, safer care
Our children-only EDs at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del., and Nemours Children’s Hospital in Orlando work together to measure the outcomes below. We chose these metrics because they’re part of the Pediatric Core Measures recommended by the Centers for Medicare & Medicaid Services, and the pediatric emergency medicine quality metrics recommended by the American Academy of Pediatrics (AAP).
Providing Safer Treatments for Common Colds
Avoiding Antibiotics for Basic Sniffles and Sneezes
It’s practically impossible to make it through childhood without an upper respiratory infection (or “URI”) like the common cold. You know the signs: coughing, sneezing, runny or stuffed up nose, scratchy or sore throat, etc. Most children who come to the Emergency Department with a URI are experiencing symptoms of a virus — and when it’s a virus, antibiotics won’t help. That’s because antibiotics only treat infections caused by bacteria, not viruses.
So why is unnecessary antibiotic use such a big deal? Well, it’s a widespread problem that causes more harm than good because it can:
- create drug-resistant bacteria
- increase the risk for allergic reactions
- add unnecessary costs to care
- cause children to take a medication that won’t help them feel or get better
According to the American Academy of Pediatrics (AAP), antibiotics aren’t an appropriate treatment for upper respiratory infections. At Nemours, we follow the AAP’s outlined best practices, so 97 percent of children with upper respiratory infections were not prescribed antibiotics. We want to make sure the children we see get the right diagnosis and treatment.
Percentage of Emergency Department Patients Not Prescribed Antibiotics for Upper Respiratory Infections, 2016
Percentage of Nemours ED patients with an upper respiratory infection not prescribed antibiotics
Data source: Nemours data determined by the total percentage of children 3 months to 18 years of age who were diagnosed with an upper respiratory infection and did not receive a medication order for antibiotic at Nemours/Alfred I. duPont Hospital for Children (in Wilmington, Del.) and Nemours Children’s Hospital (in Orlando).
Benchmark: Guidelines set forth by the American Academy of Pediatrics recommendations for managing common colds.
Appropriate Sore Throat Treatment for Kids
The Importance of Testing a Sore Throat
“Pharyngitis” is inflammation of the pharynx (or throat). So pharyngitis just means a sore throat — something most parents have faced at least once, or maybe many times. Pharyngitis also can cause scratchiness in the throat and difficulty swallowing. Although a sore throat can result from either bacterial or viral infections, in most cases it’s viral (caused by colds or flu). Sometimes streptococcus bacteria causes a sore throat (this is called “strep throat,” for short).
Children who have a bacterial throat infection do not have symptoms of runny nose, cough or hoarse voice, and should not be tested. If children who come to our emergency departments with sore throat don’t have these symptoms, we want to make sure that they’re tested for bacterial infections. Our goal is to avoid using antibiotics when it’s a virus — again, because antibiotics won’t help treat a virus. We also want to make sure we give the correct type of antibiotic treatment for bacterial pharyngitis.
Percentage of Children With Sore Throat Who Were Given Antibiotics Only After Having Appropriate Positive Tests for Strep Throat, 2016
Nemours/Alfred I. duPont Hospital for Children (Wilmington, Del.)
Nemours Children's Hospital (Orlando)
National average (benchmark)
Data source: Nemours data determined by the total percentage of children 2–18 years of age who were diagnosed with pharyngitis and received antibiotics only after a positive strep test (rapid or culture) at Nemours/Alfred I. duPont Hospital for Children (in Wilmington, Del.) and Nemours Children’s Hospital (in Orlando). A higher rate represents better performance (i.e., appropriate testing).
Appropriate Testing for Children With Pharyngitis, National Committee for Quality Assurance (NCQA).
Roberts, R., et al. (2016). “Variation in US outpatient antibiotic prescribing quality measures according to health plan and geography.” The American journal of managed care 22(8): 519-523.
Antibiotic Prescribing and Use in Doctor's Offices, Centers for Disease Control and Prevention (CDC), Sept. 27, 2017.
Antibiotics Aren't Always the Answer, CDC, April 21, 2017.
Our Differentiators: What Sets Us Apart
Why Choose Nemours Emergency Medicine
Here are just some of the reasons parents bring their children to Nemours for emergency care:
- Emergency medicine physicians board-certified in both pediatrics and pediatric emergency medicine. That means many of our doctors are specifically trained and experienced in helping children and teens who come to the emergency department hurt or sick.
Full-service emergency carethat treats only children. Our pediatric emergency care is available 24/7 at Nemours/Alfred I. duPontHospital for Children in Wilmington, Del., and Nemours Children’s Hospital (NCH) in Orlando’s Lake Nona Medical City.
- Pediatric trauma center. Our Emergency Department at
duPontHospital for Children is also home to Delaware’s only Level 1 Trauma Center for children.
- Commitment to reducing risks and improving processes. The EDs at both Nemours freestanding children’s hospitals work together to review statistics and identify opportunities to improve processes for our patients. This helps us standardize care across our health system and among individual providers.
- Dedication to educating families. We want to make sure children and families are as well-informed as possible, especially when making decisions about the use of antibiotics.
Learn more about the new emergency department that opened at Nemours/Alfred I. duPont Hospital in Wilmington, Del., in 2014.
Learn more about the pediatric ED at Nemours Children's Hospital in Orlando.
See how Nemours' care is recognized locally, across the country, and around the world. View Awards »
Nemours Children’s Hospital has twice earned The Lantern Award™ from the Emergency Nurses Association. The Florida Hospital Association also recognized NCH for patient innovation and safety in its emergency care programs — such as the Boo-Boo Care Team and the REACH low-stimulation environment for children with autism.