More Child Abuse, Fewer Sick Patients: Inside Cook Children’s Emergency Department in the COVID-19 Era
The Emergency Department at Cook Children’s Medical Center is quiet. Every once in a while, a parent walks through the automatic sliding doors and tells the nurse why they’re bringing their child in to be seen. Their temperatures are taken and they sit and wait, but not for too long. That’s because during the COVID-19 pandemic, Cook Children’s has seen a major decrease in the number of children coming through the area known as the ED.
Natalie Carpenter, RN, director of Emergency Services, says a lot has changed in just a year. In January of 2019, extra chairs lined the hallway outside of the ED to accommodate the more than 500 patients being seen per day in the height of flu season. Since the pandemic began, that number has shrunk to 250 or less.
“Because of COVID, parents just aren’t bringing their kids in out of fear that they're going to expose somebody to the virus,” Natalie said.
It’s 10:30 a.m. on a Monday morning, and a section in the ED hasn’t opened. Natalie explains the unit is closed because the volume is low. There’s not a single child or nurse in sight.
Natalie goes to find a nurse to talk about her time in the ED during COVID-19. As Wendy Benton, RN, walks into the examination room, she and Natalie discuss the happenings of the morning. Wendy has worked in Cook Children’s Emergency Department for more than a decade. She mentions how much has changed this year and her appreciation for all that she’s learned about COVID-19 during the pandemic.
“At first, we were all really afraid and didn't know what to expect. There wasn't much information or details about transmission,” Wendy said. “We were nervous about dealing with patients and not knowing how to best protect ourselves. We had some information, but everybody was still pretty tense about what it was going to be like.”
The number of patients coming in remains low, but the children they are seeing are severely ill. As Natalie walks through the ED, she stops in the “D” unit to chat with a secretary. All is quiet there.
She’s then greeted by another nurse.
“We just had to sedate a child, we had a little one pass away, go check in on “A,” they’ve got a lot going on,” he said.
“A” is the trauma unit in the ED. As we follow Natalie there, she greets several nurses along the way. Upon arrival, a team of emergency responders wheel the sedated patient into a room and close the door. The door doesn’t stay closed for long, as other medical personnel begin to walk in and out of the room. A nurse comes out and speaks to the guardian sitting outside, giving him minute-by-minute updates on how the patient is doing.
“I’m getting someone to come and help with the paperwork,” Natalie says to a member of her staff. Though there aren’t many children in the ED, staff still work around the clock to ensure they’re meeting every need.
One nurse gears up in full personal protective equipment (PPE): blue gloves, a Cook Children’s mask, another mask on top. She puts on her safety goggles and enters another patient’s room. This isn’t uncommon in the ED. Natalie explains that when the pandemic began, she ordered all the specialty items her staff would need before PPE ran out.
“The staff are having to use a buddy system to get PPE on and make sure they’re secure before going into rooms. They then trade out because being in that PPE for the length of time that we spend at the bedside with a patient is taxing,” Natalie said.
Several staff members congregate to discuss what’s going on in the unit. When a door opens, you can see parents comforting their children. Other nurses are on the phone and if you listen closely, you’ll hear the clicking from staff entering patient information into the computer.
“We have another EMS transport on the way,” one nurse says to another. This means another patient is being admitted into the ED by ambulance. The child is brought in on a stretcher with EMS personnel. A woman, who looks to be his guardian, walks in shortly after. The child is greeted by a nurse. “Hi buddy, how are you?” she asks. He’s then quietly rolled away.
As things begin to slow down in the trauma unit, we are stopped by Dan Guzman, M.D., a physician in Cook Children’s Emergency Department. He’s been making rounds and says the biggest change he’s had to adjust to is the way he interacts with his patients.
“There is a flow of how you go into a room and interact with families, and that's just been completely changed. Now, it feels like you're further away from the patients. Physically, you are just because of other concerns,” Dr. Guzman said.
The distance between caretaker and patient isn’t the only thing that’s drastically changed in the ED. Natalie, Wendy, and Dr. Guzman all made note that the number of child abuse cases has soared during the pandemic.
Parents and caretakers are struggling at home. Some parents haven’t worked in months, and others are still having to work to make ends meet and play teacher at home. Children are being left at home alone or left under the supervision of people who aren’t reliable.
“Some people haven't worked in a long time, which causes stressors at home and causes people to hurt their children because of frustrations in their everyday life. That's been a huge change that nobody wanted to see for sure. I'm glad we can be here to take care of them, but there’s been a higher volume of non-accidental trauma,” Natalie explained.
Cook Children’s is also seeing a rise in their behavioral health patients. These patients are suffering from disruptions in their normal schedules, not having regular school or recess hours, being home for long periods, and even having difficulties getting used to wearing a mask for long periods.
“We've seen a lot more behavioral health patients. Those patients usually require staff to sit with them one-on-one. There's been several incidents of those patients testing positive once they’re admitted and we've been with them in rooms for hours. That’s been very trying,” Wendy said.
Through all the changes in the ED throughout the pandemic, Natalie says she has been able to share her emergency department staff with other units and departments at the medical center. While volume has been slow in the ED, some nurses have gone to work in the Neonatal Intensive Care Unit (NICU), others have manned the COVID-19 testing drive-thru.
Natalie’s management team has also taken the lead in vaccinating Cook Children’s employees with their first and second dose of the Pfizer-BioNTech COVID-19 vaccine. More than 700 shifts have been covered for vaccine purposes, and nearly 200 shifts for registration, observers and pharmacy staff.
Despite everything going on and all the changes that have been made since the beginning of the pandemic, everyone we came across in the ED had a smile on their face, under the masks of course. Far beyond the smiles, was the combined years of service and every staff member upholding the ‘Promise’ Cook Children’s makes to every patient and family.
“I have always worked in the ED at Cook Children's. I've been here for 14 years and have never wanted to be anything other than a pediatric nurse and through COVID it has only solidified that in my mind,” Wendy said. “Taking care of kids and knowing the parents want nothing more than to help their child feel better, makes my job so much easier.”
“My love for this organization and my love for kids, that's what keeps me going,” Natalie explained. “Knowing my staff are trying to keep the promise that we made to the kids in our community, which is to take care of them, that keeps me going every day.”
About Cook Children’s:
Cook Children’s Health Care System embraces an inspiring Promise – to improve the health of every child in our region through the prevention and treatment of illness, disease and injury. Based in Fort Worth, Texas, we’re proud of our long and rich tradition of serving our community.
Our not-for-profit organization encompasses nine companies – a medical center, two surgery centers, a physician network, home health services and a health plan. It also includes Child Study Center at Cook Children's, Cook Children's Health Services Inc., and Cook Children's Health Foundation. With more than 60 primary, specialty and urgent care locations throughout Texas, families can access our top-ranked specialty programs and network of services to meet their unique needs.
We’ve worked to improve the health of children from across our primary service area of Denton, Hood, Johnson, Parker, Tarrant and Wise counties for more than 100 years. Based on the exceptional care we provide, patients travel to Cook Children’s from around the country and the globe to receive life-saving pediatric care built on leading technology, extraordinary collaboration and the art of caring.
For more information, visit cookchildrens.org.