Can we make the Emergency Department a friendlier place for kids?

From January to March 2016, NEPDC hosted a PICNIC at Massachusetts General Hospital for Children. The Pediatric Innovation Challenge for Needs in Children (PICNIC) was organized to identify opportunities for advancements in pediatric medical technology and devices. Below is a submission from Dr. Ari Cohen, Chief of Pediatric Emergency Medicine, with a call for noninvasive blood pressure monitoring in pediatric patients.

Automatic blood pressure (BP) cuffs are thought to be very standard and noninvasive instruments. But, if you have ever witnessed a 2-year-old having their BP measured, you may not agree. In the emergency department, we observe inaccurate readings or often the BP is never obtained. This is especially true during triage. The child is screaming or moving due to the discomfort that they experience.

It is common that the obtained BP measurements are much higher than normal as a result of the cuff scaring the patient or the cuff tightness causing pain. These spurious and omitted values then require rework and the whole process is repeated. By then, the terrorized child knows what is coming and screams even louder.

Patient comfort is a concerning issue; however, the even more concerning scenario occurs when the abnormal values are ignored due to alarm fatigue or complacency. The prevailing thought is that “the BP is always inaccurate in triage” and is therefore dismissed. The patient is sent home with a grossly abnormal vital sign documented in the chart. This is a potential legal nightmare. We may dismiss a truly elevated BP because the child is visibly anxious or simply not perform a reading which could result in the miss of an abnormally low BP secondary to a serious infection. We need a better mousetrap. It would save time, decrease rework, and improve the patient and parent experience.

Are you working on a noninvasive blood pressure monitoring solution? We want to hear from you! Email us at info@nepdc.org.