In Japan, the patient himself or guardian, or emergency personnel is to determine the degree of urgency, severity of the condition before consultation, system for selecting the examination location (initial emergency, secondary emergency, three-stage emergency system of critical care) is It is common. However, this concept is, what can we say it's an ideal system in pediatric emergency medicine. Children can not sue himself, reserve even less condition will change abruptly. Hidden most common complain of symptoms very high degree of urgency medical condition in children, because immediately there is also intensive that the treatment is required, the condition decision at the stage of pre-admitted to hospital, there is a limit.
Medical Center and Emergency Department accept patients 24 hours per day
Therefore, "accept the first all children, it is determined that the urgency of the condition with children in the hospital (this is referred to as" triage "), to carry out medical care in accordance with the degree of urgency," it is of pediatric emergency medicine Consider that it is ideal. Triage by, picked a serious medical condition that was hidden hardly noticed around, you will be able to link to medical care without delay. Jervis teacher is before emergency director of the Toronto Children's Hospital is one of the typical children's hospital in North America as well, "We are in for life-saving severe child of one person, willing to children of 100 people with mild We are about to visit. I have said. "
Since the congress opening of March 2002, it is a clinic with the following philosophy.
- Emergency Center is the children referred to as "Look at so sick", at any time, accept anyone.
- Emergency Center at night and (overtime) to not emergency department, not a tertiary emergency center View only critically ill patients. It does not matter be patient whether or not with the pathology of true emergency. And we are treated with all the best to the children and their families with the pain and anxiety.
- To perform emergency medical care as part of the pediatric clinic, the hospital will operate the emergency center together. Is performed first aid, it does not perform the only first aid makeshift.
- For the establishment of "Pediatric Chain of Survival", it is committed to educational activities and clinical activities related to pediatric emergency medical care to the hospital and not the hospital only.
For children, sudden illness, such as accidents and fever will come suddenly. Emergency center, so that it can help children in need in a sudden event, regardless of the cause, including the long-term consecutive holidays such as New Year's holiday and the Golden Week holidays, regardless of the day and night 24 hours a day, 365 days a year, ambulatory care attending physician of multiple name We are placing a. Please you need directly to anytime emergency center is those who wish to practice.
Attending physician of emergency ambulatory care is there and that there is a duty priority medical treatment of many patients who have been consulted, also likely to interfere with the phone correspondence of emergency transport requests from the emergency services, telephone consultation from a patientIt is not implemented.
What is triage ？
The emergency center, about 4 million children per year (in 2010 about 33,298 people, visit about 3,444 people at the inner ambulance) is visited. In the visit have been children, Some people symptoms can return home lightly, but some people who must be hospitalized heavy symptoms. Therefore, it is determined that the urgency of the symptoms, it is necessary to determine the children that must be examination immediately, we do not conduct necessarily examination to accept order. Symptoms will have consultation in favor of the higher children urgency severe.
For the children who visited the emergency center, first trained nurse (triage nurse) will hear a medical condition. Therefore, to determine the urgency of the child's medical condition, to determine immediately whether the necessary medical attention. This process is called "triage", in accordance with the degree of urgency that has been determined by the triage, determines the order of examination. Therefore, children who visited later, you may receive a medical examination first. In addition, the triage in order to perform even for children carried in an ambulance, if it is determined that a low urgency even when visited by ambulance, it may wait for the examination in the waiting room.
Most (33,298 persons) received the triage of patients who visited the emergency center in 2010, of which the most urgency is high immediately resuscitation in need of treatment patients (resuscitation triage) of about 413 people, a high degree of urgency 15 minutes within a patient in need of medical examination and treatment to goal (emergency triage) was the about 3,651 people a. Otherwise about 90% of the patients I was waiting in the waiting room. Of the patients who came to our hospital by ambulance, with about 30% of those who were true to the above resuscitation triage and emergency triage, we were waiting in the waiting room the direction of the other of about 70%.
The most important thing for the emergency center, we believe that "to a patient in need is urgent examination and treatment without delay, making a high medical examination and treatment of accuracy". To do this, it needs essential system called triage. Thank you for your understanding and cooperation of everybody.
Waiting time will change in a variety of factors. When the patient is greater, if severe symptoms, is immediately performed examination is. However, if the symptoms are mild and, the timing of patient often winter, such as when you are doing a treatment of the symptoms of heavy patient, you may wait longer. As much as possible, so we work hard with doctors and nurses so that waiting time is reduced, please understand about the length of the waiting time. Children's medical condition and the degree of urgency, by the congestion situation, sometimes having to wait more than four hours. (In particular the timing and of winter, such as public holidays, at night crowded.)
It should be noted that, while waiting for a medical examination, if there is a change in the medical condition in children, please tell immediately to the triage nurse.
Examination is performed emergency center outpatient attending physician. The results of examination, but is often judged to be coming home (about 90% of children have been coming home), you may need specialist consultation and hospitalization by medical condition. Specialist does not always have to the emergency center. It can our further wait until the specialist of the examination, there is also likely to be patient was transferred to other medical institutions that there is a specialist. If hospitalization treatment necessary takes over the hospital treatment attending physician practice. In addition, it is determined that the possible return home, if the prescription is prescribed, during the day regardless of the day of the week and we are out-of-hospital prescription (ask medicine to the hospital pharmacy).