Peds After Hours: An alternative to the ER for children (2023)

By Barbara Rybolt for Summit Medical Group

Ten-year-old Hank injured his arm at baseball practice this afternoon, but it didn't appear to be serious. It is now 7:30 p.m. and he complains that he can't raise his arm or make a fist without it hurting. How are you?

If you know, call Summit Medical GroupPediatrics after hoursOffice near you, talk to the triage nurse, tell her what's going on and make an appointment for that evening. Shortly after you call, your son sees a pediatrician, and shortly after you arrive, you walk out with Hank's arm in a soft cast and an appointment for the following morning with a Summit Medical Group (SMG) doctor — in this case, an orthopedist. The co-payment is the same as a regular in-office visit and your SMG pediatrician's records will be updated to include everything about that evening's visit.

The Pediatric After-Hours program has helped countless parents who face the choice of waiting until morning to take their child to the doctor or going to an emergency room by giving them reliable access to immediate pediatric care . SMG operates three emergency pediatric service offices in Berkeley Heights, Westfield and Livingston. Each of the sites is located within the group's pediatric practice, and staff have access to the labs, x-rays and other facilities in the building.

During a recent interview, Jane Simmons, director of women's and children's health at Summit Health Management, said the program offers "the best of a private doctor's office and an emergency room with less acute severity. We do simple things — castings for fractures, minor sports injuries, stitches for minor cuts." The staff also see and treat rashes, coughs, colds, ear infections, sore throats, and all kinds of childhood illnesses that a pediatrician would treat in his office.

Peds After Hours: An alternative to the ER for children (1)

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Best of all, the offices are open when other pediatricians' offices are closed - including weekends and public holidays. Patients can come in, but it's always best if the caregiver or parents call first to explain the child's situation, make an appointment, and then come - usually right away. That way, "there's no kid sitting in the waiting room with a fever," Simmons said. “Life has changed. Now most families are either dual-career parents or single parents - it was important to develop this program to deal with the changing family," Simmons said.

Barbara E. McDevitt, MD,once directed a similar program before going into private practice. That's when she realized the value of an after-hours program. She said, "I sent people to the ER when it wasn't necessary" because it was the only option when her office wasn't open.

Today she is one of the doctors working in SMG's Pediatrics After Hours program and couldn't be happier. "When Summit Medical Group approached me, I jumped at the chance" to work on the program.

The pediatrics after-hours program began about 40 years ago as an "extension of general office hours" so a doctor "could be available to families and patients for things that wouldn't wait until the next day," Simmons said. It was basically an in-house medical program at SMG, then about five years ago the group brought pediatricians into the ER to staff the program, she said.

Throughout the program's development process, there was a primary goal to "keep the kids out of the ER and get them appropriate care in the right place," Simmons said. "We felt strongly that we should open the doors to the entire community." This means that a pediatrician for the child being treated does not have to be a member of the Summit Medical Group.

Today there is always a doctor and/or nurse on site, as well as a full complement of triage nurses. The nurses are essential to the success of the program, staying in touch with the parents or caregivers both before the child is brought in and after the child goes home just to make sure there are no complications.

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Many of the patients are "regulars", children with asthma, others with chronic diseases, and the nurses and paediatricians have developed a relationship with the children and their parents. This relationship allows the physicians and caregivers to share information about the child's medical situation and to decide whether the child should be treated at the SMG Pediatrics After Hours office or in a hospital.

"Unless it's a life-threatening emergency, it doesn't need to be treated in an emergency room," said Dr. McDevitt.

The doctors also see many minor sports injuries, which usually occur after 5 p.m. and weekends and often do not require treatment in an emergency room. If the child makes it through the day and can be seen at 7 p.m., it saves a lot of time, hassle, and money for the parents because they don't have to leave work and the child doesn't have to go to the emergency room. They try to get patients in and out in 30 minutes or less, although that doesn't always happen, Simmons said.

“SMG really did this as a service to the community and patients. The call will be billed as a doctor's visit with additional services," said Dr. McDevitt.

"The doctors who work there have a lot of experience in pediatrics and emergency pediatric care," she said. Because the pediatrics office is in the pediatrics area after hours, it's more like an office visit and helps "allay the kids' fears," she said.

For the doctor or nurse seeing a patient for the first time, the electronic records system used by SMG means they have instant access to the patient's medical record before treating the child, and the records can be updated when the patient is removed goes. If the patient is from the community, the records can be sent to their regular pediatrician.

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SMG offers after-hours pediatric offices in Berkeley Heights, Westfield and Livingston. The Berkeley Heights office is located on the flagship campus, 1 Diamond Hill Road, (908) 277-8601. The Westfield office is at 574 Springfield Ave., (908) 277-8601 and the Livingston office is at 75 E. Northfield Road, (973) 436-1540. The Berkeley Heights and Westfield offices are open Monday through Friday from 4:00 p.m. to 9:00 p.m. and from 8:30 a.m. to 5:00 p.m. on Saturday and Sunday. The Livingston office is open from 1pm to 9pm. Monday to Friday and from 8:30 a.m. to 5:00 p.m. on Saturday and Sunday. Visit website or call to check bank holiday opening times as these are subject to change.

CDC drops nasal flu vaccine

ThatCenter for Disease Control(CDC) has ruled that the nasal flu vaccine will not be used this year. ThatAmerican Academy of Pediatricsagrees with this decision, although nasal spray vaccination is the preferred choice for many parents of younger children.

On June 22, the CDC's Advisory Committee on Immunization Practices (ACIP) voted today that live attenuated influenza vaccine (LAIV), also known as "nasal spray" flu vaccine, should not be used during the 2016-2017 flu season. ACIP continues to recommend annual influenza vaccination with either the inactivated influenza vaccine (IIV) or the recombinant influenza vaccine (RIV) for everyone six months of age and older."1

The reason for the change was that after reviewing the data, the CDC Advisory Committee concluded that "the nasal vaccine has not been as effective as the immunizations over the past two years," said Barbara E. McDevitt, M.D., an im Pediatrics After Office Program.

"People are dying from the flu, including children," she said, urging parents to get vaccinated to "protect the children and babies." Children under six months cannot be vaccinated. So when there's a new baby in the house, she recommended everyone in the household and those who are likely to visit the baby get a flu shot.

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Resources:

1. "AAP Issues Influenza Vaccine Recommendations for 2016-17 Season"

2. "ACIP Rejects Use of LAIV for 2016-2017 Influenza Season"

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