by Ann M. Colford

For any parent, a sick or injured child causes worry and stress. When it's 4 o'clock in the morning and the Tylenol has worn off and your child is showing symptoms you've never seen before, parental stress goes off the charts. The doctor's office doesn't open for several hours, there's no one around to watch the other children and your judgment is clouded by nerves and lack of sleep. If only there were someone to talk to, you think, everything would be OK.

Fortunately, a calm and reassuring voice is just a phone call away, thanks to the Pediatric After-Hours Program -- or Peds After-Hours for short -- at Sacred Heart Medical Center. Most Spokane-area pediatricians, except for those with Group Health, contract with the program to provide coverage for their patients during nights and weekends. (Group Health has a 24-hour consulting nurse program for its members.) The program's clinic opens for urgent care services from 1-9 pm on Saturday and Sunday, and a nurse is available for telephone consultation through the overnight hours.

Trish Naughton, a registered nurse, is one of the overnight nurses for the program, and she's a steady and knowledgeable presence for worried parents who call in at all hours. She's been doing this for five years now, after a 12-year stint in pediatric intensive care, and she says it's a very different kind of nursing than anything she's done before.

"As a nurse in the emergency room or ICU, the whole thing is to look, listen and feel," she explains. "Well, [over the phone] you can't look and you can't feel. So you have to bring all the senses in to listening, and finding out what the parents are seeing."

Calls come in from all over Eastern Washington and North Idaho, and Naughton never knows what she'll be asked to handle when the phone rings. "You don't know where it's coming from and you don't know what the problem is," she says. "It could be anything."

She has a book of protocols to follow for alphabetical complaints from anaphylaxis to wheezing, along with a Rolodex filled with referral numbers for doctors, hospitals and emergency services across the region. But when a call comes in and a panicky parent is on the line, Naughton must assess the situation quickly and decide on a course of action. Sometimes a little bit of reassurance and advice is all that's needed; other times, she'll recommend an appointment with the child's pediatrician the next day and fax a follow-up request to the office. Some conditions call for immediate medical attention, however, and that brings up other issues.

"At night, the ER is the only place open in Spokane, so we find out first if they're able to get the child to the ER and which one they want to go to," she says. "Sometimes that's dictated by insurance, but if they're in real trouble, we have them go wherever's fastest. For people without cars, the cabs do run, and [public assistance] coupons will pay for the cab ride to the nearest emergency room."

Often parents must arrange for care for their other children before they can leave, and Naughton will stay on the line until she knows the situation is under control. If she believes the condition is life-threatening, Naughton is able to patch the caller over to a 911 operator to summon a local emergency response team. "If it's an emergency, I'll stay on the phone until the EMTs arrive," she says. "Often the parents are just terrified."

Even when a call is not an emergency, language barriers may complicate the response, given the reliance on parents' ability to communicate. Naughton says she can dial up a translation service, if needed, or use a TDD service if the caller is hearing-impaired, but she puts great stock in parents' knowledge of their children.

"Trusting the parent's judgment is the bottom line with triage," she says. "If a child sounds really ill or if the parent wants them to be seen, then they get referred, because the parents are there and they know their kid."

Naughton says she enjoys sharing information with parents, even if they might feel their questions and concerns are silly. "Getting to do teaching with people and guiding them through something -- that's what I think is exciting," she says. "At night, the world is different, and we're different. We don't have the same resources we do during the day. Most of the world's asleep. Grandmas aren't around as much anymore to ask those kinds of questions. [Young parents] are kind of on their own. And it's scary. You can hear it in their voices."

But when they call Peds After-Hours, they're not alone anymore. Naughton says she seldom learns the outcome of an individual call, but occasionally a parent will call back to say thanks. "Once, a young mom called back the next day," she recalls. "She said, 'When I called and talked to you, I knew that you and I could get through it.' It's like holding a hand."

To reach Sacred Heart's after-hours help, call 474-5303.

Publication date: 08/28/03

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