Pediatric emergency ward moves in


On November 27 at 6:00 a.m., the pediatric emergency ward in Karolinska University Hospital’s new hospital building in Solna went live. Then, when the reception was filled with sick children and their parents, the staff was ready in the new settings.

Just a few days before the big move, not everything was in place in the pediatric emergency ward's new facilities. Most of the equipment was moved overnight the night before November 27 and operations went live at 6:00 a.m. in the morning. Then, when the reception was filled with seriously ill children and their parents, when ambulances began rolling in, the staff was ready in the new settings.

"It's probably unavoidable that it feels a little out of the ordinary and messy at first, but it will work safely for the patients," says Malin Rydh Rinder, Function Area Head for Emergency Care at the Astrid Lindgren Children's Hospital.

When we walk around the bright facilities together with Malin Rydh Rinder and Pia Malmquist, Function Unit Manager of the Pediatric Emergency Ward, we get an impression of the idea behind the structure of the new emergency ward. In the entrance, there is a reception, followed by a "triage" where an initial assessment is done with the task of allocating the children between three modules, where care teams will be responsible for five or six patients at a time. Each module has examination rooms and observation rooms and should essentially be a unit that works independently. The office is centrally located in the module, where the staff has a good view of two adjacent examination rooms.

"Every team is given a major responsibility and all of the staff members will have distinct roles. We will have a better possibility to keep track of the team's patients in the new facilities. The doctor in charge will be mobile and will move around in the department when support is needed," says Malin Rydh Rinder.

In the new operational model, the care will even more clearly focus on the patient's needs and gather the competencies around the patient and not according to the division into different clinics. A similar approach has already been used at the emergency ward, where care is based on the patient's problems and then help is obtained from various resources as necessary if the patient's problems cannot be addressed within the unit.

"We want to move away from the old idea that patients are divided into clinic-specific flows, such as surgery or medicine, when seeking help for a problem. After all, before examining and investigating the patient, you can't know if he or she has a stomach ache because of constipation, appendicitis or diabetes," says Malin Rydh Rinder.

The triage has the task of assessing how quickly a patient needs to be treated, but already there, some examinations and tests can be initiated.

Radiology and all of the care wards that are moved over from the old facilities will be above the emergency ward in the same building. That move also took place on November 27. A few days earlier, the adult cardiopulmonary and thoracic departments moved in as the closest neighbors.

Access to emergency care around the clock means that, although there are alternatives, many people nonetheless go to the hospitals. Pia Malmquist estimates that around half of those who come to the pediatric emergency ward could receive good care elsewhere, either at a healthcare center or, for more minor cases, with the help of the healthcare information service. Quickly taking good care of the most seriously ill children is difficult if the emergency ward is overflowing with slightly ill children, which is a well-known and difficult challenge for emergency wards the world over.

"We will work to reduce the acute flows on the long term and are naturally continuing to work on directing the less ill children to local healthcare," says Malin Rydh Rinder.

The emergency wards have become ever better at completing the treatment of patients so that they do not need to be admitted to another ward or referred on to a specialist. For example, a child with a displaced wrist fracture can be taken care of with a reposition (placing the joint correctly) and a cast at the emergency ward. It saves both time and resources for both the hospital and the patients.

Statistics from the Astrid Lindgren Children's Hospital show that 85 to 87 percent of the children who go to the emergency ward can go home the same day. Since 2012, admissions following concussions have been reduced by 80 percent and by 50 percent for abdominal pain through better diagnostics.

Since the new pediatric emergency ward is a little further away from trauma centers until the adult emergency ward moves in 2018, its own trauma unit will be strengthened, and one of the rooms at the emergency ward will be especially equipped for the most severe cases, including its own blood bank.

"Together with surgery, radiology and anesthesiology, we have built a new organization in the past eight months. It's now being brought into use," says Pia Malmquist.

An important task for a hospital designated as a university hospital is of course also to serve as a center for education and research.

"We always have a large flow with various kinds of students, doctors and nurses who are in various phases of their education so it is definitely a workplace for learning, a school of medicine that it should be fun, welcoming and stimulating to come to," says Malin Rydh Rinder. "We also want to increase the research activity in pediatric emergency care. Having an emergency ward with a good working environment and a good development climate benefits both our patients and employees."

Facts about the new hospital

In June 2016, Karolinska University Hospital took over part of the newly built hospital building in Solna. Intensive work has been under way to prepare the facilities and receive patients. On 20 November, the first patients moved in to Karolinska's new hospital building. First in were patients in the cardiopulmonary and thoracic departments. On November 27, part of the Astrid Lindgren Children's Hospital in Solna moved in. The rest of the new building is still under construction and the whole hospital will be finished in 2018. The most advanced and highly specialized care will then be gathered in the new hospital.

New pediatric emergency ward

The pediatric emergency ward is one of the pediatric units that moved in to Karolinska's new hospital building on November 27. The pediatric emergency ward is for serious accidents or serious acute illness that requires immediate care, and at the pediatric emergency ward in Solna, the most severely ill children are prioritized – they get help first.

Text: David Grossman. Photo: Jennifer Glans