Pediatric Radiology

, Volume 38, Supplement 4, pp 655–659 | Cite as

The art of communication: strategies to improve efficiency, quality of care and patient safety in the emergency department

  • Steven E. KrugEmail author


The practice of pediatric emergency medicine (PEM) has been supported by wonderful advancements in diagnostic testing, particularly in medical imaging. One of the most remarkable has been CT, which has arguably become our most valuable diagnostic tool in the emergency department (ED). PEM specialists have grown increasingly aware of quality and safety concerns in the care of children in emergency medical settings, spurred in part by a rapid growth in ED utilization and significant overcrowding. In the midst of this comes the revelation that one of our most valued diagnostic tools might place our youngest patients at a significant risk for the development of fatal cancer. This article reinforces the fundamental importance of communication and teamwork as a means to promote patient care quality and safety in the ED, and it offers partnership strategies for PEM and pediatric radiology specialists to consider as they address these important concerns.


Patient safety Emergency department overcrowding Radiation safety Medical imaging Pediatric emergency medicine 


  1. 1.
    Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284PubMedCrossRefGoogle Scholar
  2. 2.
    Brody AS, Frush DP, Huda W et al (2007) Radiation risk to children from computed tomography—clinical report. Pediatrics 120:677–682PubMedCrossRefGoogle Scholar
  3. 3.
    Frush DP, Donnelly LF, Rosen NS (2003) Computed tomography and radiation risks: what pediatric health care providers should know. Pediatrics 112:951–957PubMedCrossRefGoogle Scholar
  4. 4.
    Institute of Medicine Committee on the Future of Emergency Care in the United States Health System (2006) Hospital based emergency care: at the breaking point. The National Academies Press, Washington, DCGoogle Scholar
  5. 5.
    American Academy of Pediatrics Committee on Pediatric Emergency Medicine (2004) Overcrowding crisis in our nation’s emergency departments: is the safety net unraveling? Pediatrics 114:878–888CrossRefGoogle Scholar
  6. 6.
    American College of Emergency Physicians Crowding Resources Task Force (2002) Responding to emergency department crowding: a guidebook for chapters. American College of Emergency Physicians, Dallas, TXGoogle Scholar
  7. 7.
    Richardson LD, Asplin BR, Lowe RA (2002) Emergency department crowding as a health policy issue: past development, future directions. Ann Emerg Med 40:388–393PubMedCrossRefGoogle Scholar
  8. 8.
    Derlet RW, Richards JR (2000) Overcrowding in the nation’s emergency departments: complex causes and disturbing effects. Ann Emerg Med 35:63–68PubMedCrossRefGoogle Scholar
  9. 9.
    Ottawa Health Research Institute (2008) Emergency medicine research: clinical decision rules. University of Ottawa. Available at Accessed 15 February 2008
  10. 10.
    American College of Emergency Physicians (2001) Patient safety in the emergency department environment report. Available at Accessed 14 February 2008
  11. 11.
    Institute of Medicine Committee on the Future of Emergency Care in the United States Health System (2006) Emergency care for children: growing pains. The National Academies Press, Washington, DCGoogle Scholar
  12. 12.
    Gausche-Hill M, Schmitz C, Lewis R (2007) Pediatric preparedness of US emergency departments: a 2003 survey. Pediatrics 120:1229–1237PubMedCrossRefGoogle Scholar
  13. 13.
    American Academy of Pediatrics Committee on Pediatric Emergency Medicine and American College of Emergency Physicians Pediatric Committee (2001) Care of children in the emergency department: guidelines for preparedness. Pediatrics 107:777–781CrossRefGoogle Scholar
  14. 14.
    Frush KS, Krug SE, American Academy of Pediatrics Committee on Pediatric Emergency Medicine (2007) Patient safety in the pediatric emergency care setting. Pediatrics 120:1367–1375PubMedCrossRefGoogle Scholar
  15. 15.
    Hall EJ (2002) Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol 32:700–706PubMedCrossRefGoogle Scholar
  16. 16.
    Brenner DJ (2002) Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32:228–231PubMedCrossRefGoogle Scholar
  17. 17.
    Brenner DJ, Elliston CD, Hall EJ et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296PubMedGoogle Scholar
  18. 18.
    Patterson A, Frush DP, Donnelly LF (2001) Helical CT of the body: are settings adjusted for pediatric patients? AJR Am J Roentgenol 176:297–301Google Scholar
  19. 19.
    Lee CI, Halms AH, Monico EP et al (2004) Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 231:393–398PubMedCrossRefGoogle Scholar
  20. 20.
    Donnelly LF (2005) Reducing radiation dose associated with pediatric CT by decreasing unnecessary examinations. AJR Am J Roentgenol 185:655–657Google Scholar
  21. 21.
    Frush DP, Frush KS (2006) In a new kind of light: patient safety in pediatric radiology. Clin Pediatr Emerg Med 7:255–260CrossRefGoogle Scholar
  22. 22.
    Larson DB, Rader SB, Forman HP et al (2007) Informing parents about CT radiation exposure in children: it’s OK to tell them. AJR Am J Roentgenol 189:271–275PubMedCrossRefGoogle Scholar
  23. 23.
    O’Malley P, Brown K, Mace SE, American Academy of Pediatrics Committee on Pediatric Emergency Medicine (2006) Patient and family centered care and the role of the emergency physician in providing care to a child in the emergency department. Pediatrics 118:2242–2244PubMedCrossRefGoogle Scholar
  24. 24.
    Graedon J, Graedon T (2006) Enlisting families as patient safety allies. Clin Pediatr Emerg Med 7:265–267CrossRefGoogle Scholar
  25. 25.
    American Academy of Pediatrics Council on Children with Disabilities (2005) Care coordination for children with special needs. Pediatrics 116:1238–1244CrossRefGoogle Scholar
  26. 26.
    Ball JW, Liao E, Kavanaugh D et al (2006) The emergency medical services for children program: accomplishments and contributions. Clin Pediatr Emerg Med 7:6–14CrossRefGoogle Scholar
  27. 27.
    Dayan P, Chamberlain J, Dean JM et al (2006) The pediatric emergency care applied research network: progress and update. Clin Pediatr Emerg Med 7:128–135CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Children’s Memorial Hospital, Feinberg School of MedicineNorthwestern UniversityChicagoUSA

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