Pulmonary embolism in the pediatric emergency department: a case demonstrating the application of point-of-care cardiac ultrasound in a pediatric patient with pulmonary embolism.

Although pulmonary embolism in children is rare, it is important for the pediatric emergency medicine provider to be aware of its presentation and emergent management. We present a case of bilateral pulmonary embolisms in an adolescent patient to illustrate the benefits from the timely diagnosis of right ventricular dysfunction by point-of-care echocardiography performed by emergency medicine physicians. Ultrasonographic techniques and the emergent management of pulmonary embolism are reviewed.

A new after-hours clinic model provides cost-saving, faster care compared with a pediatric emergency department.

OBJECTIVE: The objective of this study was to compare the charges and length of stay of demographically and clinically matched nonemergent patients managed in a new After-Hours Clinic (AHC) model versus a pediatric emergency department (PED). METHODS: Retrospective cross-sectional study conducted in a tertiary-care urban academic children's hospital. The AHC was off-site from the children's hospital emergency department. After-Hours Clinic patients were matched with PED patients for age, date and time of presentation, and chief complaint. The 95% confidence intervals for the difference in the means were used to compare the outcome variables of charges and length of stay. RESULTS: Of 471 patients seen at AHC in January 2008, 130 were matched to PED patients for date and time of presentation, age, and chief complaint, giving 260 study patients. There was no significant difference between AHC and PED patients in relationship to date and time of presentation, sex, age, and chief complaint. Comparing the length of stay and charges between AHC and PED patients revealed a significant difference in each. The patient-visit length-of-stay mean time for the AHC was 81.2 minutes less than the mean time for the PED (95.6 vs 176.8 minutes). The patient-visit mean charge for the AHC was $236.20 less than the mean charge for the PED ($226.00 vs $462.20). CONCLUSIONS: Our AHC model showed a significant reduction in length of stay and charges in compared demographically and clinically matched PED patients. This may be an effective model to help address emergency department overcrowding and promote patient safety.