During an intense bout of croup, 3-year-old Aiden Taylor passed out at home and was rushed by ambulance to Marin General Hospital with his mother, Cathy — his father, Michael, followed by car. Although Aiden recovered from the infection, the calloused emotional treatment the Taylors experienced in the emergency room in early 2015 spurred Cathy’s commitment to transform Marin General’s pediatric emergency department to “Ouchless” — a holistic philosophy of care that not only addresses children’s physical needs, but also their (and their parents’) emotional needs.
“When I arrived at the ER, the nurse was very cold and explained the hospital was enforcing a one visitor per patient rule because of a high incidence of flu,” Cathy said. “Aiden was clinging to me, asking where his dad was, but wasn’t able to see him because the nurse made me choose between my husband or myself.”
Cathy, an ultrasound technician at the University Of California, San Francisco, also noticed further red flags that added to the chaos. When a young boy was brought in with both parents and Cathy pointed this out, a nurse began yelling at the boy’s family, who didn’t speak English, and told them one parent needed to leave immediately. Cathy observed that this exchange lacked the standard cultural sensitivity expected in hospitals, as no translator was offered.
The following day, Cathy filed a complaint with patient relations and the hospital modified their one visitor per patient rule within 24 hours. However, she was still angry and knew more needed to be done to improve how children, and families, were treated in the ER.
“It’s been long-standing knowledge that we don’t have good pediatric emergency care in Marin,” Cathy said. “We usually have to go over the Golden Gate Bridge to a children’s hospital. In an emergency, we can’t be dependent on this, especially because children make up 20% of Marin’s population.”
Over the next six months, Cathy’s anger shifted to productivity as she began diligently attending the Marin Healthcare District’s monthly board meetings, learning all she could about key players, and listening to what the community had in mind for Marin General’s future. She and Michael formed a business plan, and in June of 2016, Cathy pitched her Ouchless ER model to the hospital board. She used past Ouchless projects as examples, as well as results from a 2013 national pediatric readiness survey that showed that many community hospitals in California lack basic emergency tools — the average rating being a C-. To raise money for the project, Cathy proposed (and executed) a community matching fund. The entire Ouchless platform was well-received by the hospital administration.
“When I finally spoke up in the meeting, everyone was floored to find out that I was just a mom who was really angry, and I had an idea of how we could do better for our children,” Cathy said. “The administration loved the idea and immediately had me in the office the following day, and from there it plays out just like a Disney movie.”
An Ouchless Executive Committee was formed, and a $30,000 donation was secured from the Schultz Foundation (named after Andrea Schultz, who chairs the Marin General Foundation Board of Directors) as well as an additional $120,000 from the hospital itself. Staff from Benioff Children’s Hospital came to Marin General and trained the pediatric emergency department on new Ouchless-friendly equipment, different pain management techniques, and how to address the various developmental levels of children. The hospital began employing Ouchless techniques in November of 2016.
“The important part of this program is allowing children to feel like they have choices and that they’re in control,” said Michelle Tracy, director of emergency and trauma services at Marin General. “We also understand that you don’t just have one patient, but two or three, including parents.”
In the days before Ouchless, parents would observe while nurses worked, resulting in a very traumatic experience for all. Now, through training, staff has learned that you include parents as often as possible. For instance, children now sit on their parents’ laps while nurses draw blood, in rooms painted with bright, fun designs.
The new program also focuses on distraction techniques such as blowing bubbles, reading books, or playing with blocks when a procedure (such as a blood draw) is done. Dolls are used to explain what will happen, and shots are given through a J-tip “needle,” which is actually a syringe that works through air compression to numb the skin before a shot or IV is given. Pain and anxiety medication are administered through a fast-acting nasal mist, and for older children who aren’t too afraid of shots, a vibrating toy bee with an ice pack is placed on the arm to numb the injection site.
“We’re already starting to get a lot of thank you notes,” Michelle said. “When children leave the ER, they don’t look like they’ve been traumatized. They’re leaving with smiles on their faces and saying thank you to the staff.”
For Michelle, establishing this type of pediatric emergency program at Marin General has always been a goal — both for professional and personal reasons. Years ago, she and her then 4-year-old daughter were in a bad car accident in New York and transported to the hospital where Michelle was employed as a nurse. Similar to Cathy, Michelle experienced less-than-empathetic care in the emergency department. Staff assumed she was drinking (false) and, after 72 hours, casually told her she would need to look into home care options for her daughter, who survived but would be severely brain damaged and require months of rehabilitation.
When she finally went back to work in New York, she entered the pediatric emergency department and made sweeping changes to the program, spending her time advocating for patients and families and learning how to care for the caregiver. With all the West Coast focus on cardiac, trauma, and stroke care, Michelle was never able to fully focus on pediatrics until she connected with Cathy.
“Cathy and I immediately bonded, and she helped make pediatrics a forefront item when she came into the picture,” Michelle said. “I couldn’t have done it without her, and she couldn’t have done it without me.”
The Ouchless program has been well-received within Marin General, with requests from different departments for their own trainings. Tracy plans to hire a child life specialist, an individual who helps families deal with all aspects of hospitalization and illness, to work alongside children wherever they go in the hospital. She’s also formalizing an Ouchless training model that will be shown to all new hires, and that can be shared with other hospitals.
Cathy’s ongoing goal is to expand Ouchless to different hospitals by empowering parents to advocate for this powerful model of care within their local hospitals.
“If you want a solution, be a part of it, and if you’re angry about something, figure out what role you can play,” Cathy said.