If you thought handling next of kin notification for adults was tough, try critically ill children!
the head of the trauma department at one of America’s top
pediatric facilities, Chicago’s Lurie Children’s Hospital,
having to notifying parents that their children have been the
victims of trauma or identify pediatric Jane Does, is an every day
occurrence. But just because they look like they’re handling
it well, doesn’t mean that it ever becomes routine.
a child comes into the emergency department without a parent, it’s
usually the result of an accident or traumatic event. Even
though their first priority is to tend to the child’s medical
needs, their next priority is to identify the child. They need
to get his parents or guardian down to the hospital, to give consent
for his treatment, provide vital medical history and most
importantly, to be at their child’s side when he needs them most.
be surprised how often a child is brought into Children’s without
anything pointing to his or her identity. Many times it’s
the result of a car accident, where the parents are injured as well
as the child, and are taken to another hospital, while the child is
brought to Children’s for specialized pediatric treatment. Since
children don’t have driver’s licenses or checkbooks, identifying
them can be challenging.
the other day, three children ranging from 8 months to 3 years were
brought into the ED after a serious automobile accident.
parents, who were in bad shape, were taken to another hospital and
the paramedics had no clue about their names, ages or medical
history. The trauma team began their medical evaluation, and
as they always do when dealing with an unidentified child, opened a
trauma pack for each, using a patient number to identify them.
They estimated their ages, did a full physical description
including any identifying marks and clothing, then ordered a full
set of x-rays, which helps to identify any conditions or injuries
that aren’t readily apparent.
team’s biggest asset in this situation was the solid relationships
that they’ve built with police, fire department, and other local
hospitals – as they work together to get the children identified
as quickly as possible. After a major accident like this, the
police and fire department were already in the ED coordinating
efforts. With their special emergency landline system
they’re instantly linked by phone with any local hospital they
need to reach.
the team began calling to find out where the children’s parents
were taken, hospitals began to call them, to say, “I know you’re
looking for the mom and dad of the accident victims. They’re not
here,” saving them precious time. In this case, they found
the hospital relatively quickly and found out that even though the
children’s parents had been seriously injured, the children’s
caregiver who had also been in the accident, was fine. The
hospital sent her over to Children’s and she – and later on the
parents – were able to give them all the information they needed
to treat the children.
the case of a completely unidentified child, especially babies,
Children's relies upon their finely honed procedures.
Usually the fire department, police or DCFS dropped the child off,
so they are already aware of the situation and have already begun
going through the child’s clothing and personal effects to gather
evidence and identify the child. The trauma team will send the
police or paramedics right back to the scene to gather additional
information, medicine bottles, names, and to canvass the area.
There is almost always someone who saw something. Someone from
pastoral care automatically comes down and a social worker will get
involved if it looks like any abuse was involved. Together, they
take care of figuring out where to go from there, while the team
takes care of the child medically.
these steps don’t elicit any clues to the child’s identity, the
hospital will get media affairs involved. Children’s will
never show the face or reveal the name of any child. Instead,
they photograph the child’s clothing and personal effects and
release it to the media along with the child’s estimated age,
description and the vicinity in which she was found. They work
closely with detectives and DCFS to give them all the details they
need to chase down any leads they get from the public. Many times
just calling DCFS or the police will locate parents or bring about
an identification. In the case of severe trauma, abuse or
inflicted injury, Children’s always balances treating the child,
with carefully gathering as much evidence as possible, to help the
eventual police investigation. They had a young girl a few
years ago, whose brutal attacker was convicted mainly on the
evidence gathered and catalogued in the trauma room.
it comes to providing emergency contact information, kids aren’t
always the best source. They have seven or eight year old kids come
in everyday, who are sophisticated in every other way. But get
them in a trauma situation and ask them what their mom’s name is
and they’ll say it’s “mom”. In this case,
the first thing they’ll do is look at whatever they brought in
with them. School-age kids almost always have a backpack. If they
don’t find anything there, they’ll check their records to see if
the child is in the system and begin to gently probe the child for
information. They ask them where their house is, what their
school looks like, information about their friend’s houses, maybe
a familiar landmark on the corner like a 7/11 or the name of a park.
If you can’t find their contact information right away, try to
find the name of their school. Their books will probably have the
name of their school stamped inside.
are also a great source for emergency contact information. They’ll
often even list alternate people to call in an emergency if the
parents are at work or hard to reach. In an emergency, schools
will usually send someone directly down to the hospital with the
child’s emergency card and emergency consent forms. If the
injury occurs at school, most schools will send someone from the
school along with the child to the hospital, while someone else is
calling the parent. For parents, Children's suggests that
every parent name someone else on the child’s emergency card.
Someone who knows the child well and would be able to step in
to help out during an emergency if the parents can’t get there
once you identify a child, how do you know if the person who comes
to the hospital is really his parent or relative? It’s not
always easy. Remember that the parents didn’t expect to have to
come to the hospital today, and probably won’t be carrying three
forms of ID and their child’s birth certificate. For people that
come in and say they’re related to a child who’s been in the
media, they get as much ID as they can, be it a driver’s license,
pictures or other proof. With kids, the biggest test is to
watch their response when that person goes in the room. Usually
you’ll here a resounding “Mom!” or “Daddy!” and you know
you’ve got the right person. If there’s no response from
the kid, or if they’re not sure of the adult, it’s probably not
the right person. Or worse, the child might recoil from the adult,
which could indicate an abusive situation.
kids also means caring for their parents. When Children’s
has to make a notification call they’ll begin by telling the
person on the phone who they are and ask them how they are related
to the child. If it’s the mom or dad, they’ll tell them
that their child has been brought to Lurie Children’s Hospital.
Of course the parent will immediately ask how the child
is. This is always the hardest part of the call. If
the child is clearly fine, they’ll say “Don’t worry, they’re
fine, we just need you to come down here.”
if there is a more serious injury, or if the child hasn’t
survived, they say that the child has been in an accident, that they
need to come down, and if necessary, that they need to get their
medical history. If they refuse to get off the phone until
they find out what’s wrong, the trauma coordinator will say that
they’re very concerned about their child’s health and that they
need to come down right away. They’ll always try to calm the
person down as much as they can – tell them to go and get a pencil
and paper to take down the address of the hospital, to take down the
hospital’s name and the nurses' direct number. They tell
them to ask for them right away when they get there, so they don’t
have to waste any time at the desk and then try to make sure they
have someone to drive them over. And they finish by reminding
them that they need to drive carefully and slowly and to make sure
that they get there in one piece!
Children’s the top priority is the restoration of the health of
every child who comes through their door, no matter who they are and
where they come from.
Learning how to do Pediatric Notifications is just ONE way to increase patient safety, health and satisfaction while reducing liability.
We have many more in our book Notify In 7.
In 7 is filled with tools you and your hospital staff can use
to facilitate NOK notification, patient identification and
If you want to create change throughout your entire facility, our Six Sigma based, HIPAA-friendly, “Creating A Next of Kin Notification Program” has everything you need to roll out the Seven Steps facility-wide. The Program includes patient tracking workflows, tools and training materials, based on Notify In 7. It provides your Emergency Department staff, managers and Risk Management professionals with comprehensive training, giving you and your hospital a fully operational Next of Kin Notification System in ninety days.
Laura and Janet Greenwald, are the founders of The Next of Kin Education Project and Stuf Productions. The mother & daughter team were not only instrumental in enacting three Next of Kin Laws in California and Illinois, but created the Seven Steps to Successful Notification System, which teaches quick, easy, next of kin notification skills for trauma patients to hospitals like Dallas’ Methodist Medical Center.
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