Determination, teamwork allow more pediatric patients to stay in Yampa Valley for care
What do you get when you combine a) the desire to keep pediatric patients close to home, b) additional training for health care workers to work at the top of their scope and c) a nurse manager committed to addressing social determinants of health through access to care?
A pediatric intermediate care unit at UCHealth Yampa Valley Medical Center.
“We’ve had pediatric patients who were higher acuity than our medical/surgical status, but not acute enough for our intensive care unit (ICU). In those situations, we transfer the patient to a higher level of care,” said Jenny Przymus, nurse manager of YVMC’s med/surg and ICU departments.
“But, the transfer may only be needed for a few hours, then they’re discharged. We kept saying, ‘Wouldn’t it be great if these patients could stay at YVMC in hopes of stabilization so they wouldn’t have to leave the community for care?’”
Many of the pediatric patients Przymus had in mind are those who experience diabetic ketoacidosis, or DKA – a condition that indicates a severe lack of insulin.
“If an adult presented with DKA in our emergency department (ED), an insulin drip would be started and they would then be admitted to our ICU,” said Przymus.
“But, if it were a child, they’d stay in the ED and likely transfer out quickly. We have an incredible team of physicians, nurses and staff here. By setting guardrails and doing some work and training, I felt we could keep more patients in the Yampa Valley.”
Przymus and her team knew they wouldn’t be able to keep every pediatric patient local, but “even if one family had the opportunity to stay at YVMC for care, it’d be a win,” she said.
Multidisciplinary teamwork led to aligning workflows, revising policies and establishing consistent admission and care practices for pediatric patients, both those with DKA as well as other pediatric conditions. All ICU staff completed pediatric advanced life support training, and they and other hospital staff participated in an eight-hour in-person course focused on trauma, respiratory illnesses and DKA.
As patients present for possible admission to the pediatric intermediate care unit, each patient and their condition is reviewed to ensure they will receive the right level of care.
The work has made a difference.
“While eight patients may not seem like a lot, for those patients and their families, it was huge. They were able to stay in their hometown to receive the care they needed and could focus more on healing than the stress, logistics and cost around transferring to a different facility, traveling, being away from home, etc.,” Przymus said.
Przymus has a vision to add more capabilities to the pediatric intermediate care unit, allowing patients needing psycho/social support or treatment for other medical conditions to stay for care.
“This work provides our teams with tools and education to best serve as many pediatric patients in our community as possible,” she said. “As a nurse and as a mom, I feel really good about that.