Pioneering Pediatric Care - The Rise of Sanford's Pediatric Emergency Department
By Alex Strauss
Sanford Pediatric Emergency Medicine specialists, Mason Ruthford, MD, and Donald Ellis, MD
Stomach aches, respiratory infections, lacerations, and fractures may be all in a day's work for a busy emergency department like Sanford Health's. But when the patient is a child, even a routine case may turn out to be anything but.
"When a child comes into the ER, their needs are going to be different from an adult," says pediatric emergency medicine specialist Donald Ellis, MD, a Delaware native and the father of seven. Ellis says pediatric emergency medicine specialists have to consider not only differences in anatomy and physiology, but also differences in mental and emotional maturity.
"With an adult, you can say 'Sit here in this chair and we'll take care of you in a few hours'," says Dr. Ellis, whose arrival in 2022 marked the start of Sanford's pediatric emergency medicine program. "But you can't say that to a toddler, or even a teenager who might have a lot of anxiety. It's not just about age but also developmental level."
"A lot of times, the procedure itself might not be any different than what we would do in an adult," adds Ellis' partner, Mason Ruthford, MD. "The difference is in what we do before and after a procedure."
"For instance, with a laceration, in adults, you can do injectable lidocaine. An adult is going to get through that. But a kid might freak out just seeing the lidocaine needle. So we might need to consider sedation, but that requires additional conversation with parents because those drugs are not without risk. Then we might have to wait for them to wake up and clear of sedation. A kid might be there for two hours."
Even a broken bone that might be treated by straightening and offering pain medication to an adult, could necessitate surgery in a pediatric patient, with all of the complexity and considerations that go with it.
"We do see a lot of routine cases, but we also see some very medically challenging cases," says Dr. Ellis. "We have fantastic emergency medicine specialists here, but we have had such an explosion of population that Sioux Falls was ready for this very specific skill set."
"When you look at what a typical ER doctor sees, it's going to be 78 to 90 percent adults," says Ruthford, a South Dakota native and parent of two small children. "But we all become less comfortable with things we see less often and there is a difference in the care that is offered when you see a specialist as opposed to a generalist. Pediatric emergency medicine requires a much more gentle approach. We want children to be comfortable and safe."
Drs. Ruthford and Ellis are part of Sanford's response to the needs of the region's growing pediatric population.
Growing to Meet Demand
In its first 18 months, Sanford's pediatric emergency department has grown along with the need for it. In addition to a dedicated, child-friendly waiting area for pediatric emergencies, the department recently added additional pediatric rooms with soothing colors and playful murals.
"Having a separate waiting room for families and kids is crucial to making the child feel safe right off the bat," says Ruthford. Those dedicated pediatric rooms, along with some new procedural efficiencies during the high volume afternoon hours, also mean shorter wait times for families, even as more of them are coming through the doors.
The team has grown, too. It now includes four pediatric emergency medicine specialists -- pediatricians or emergency medicine specialists, who have completed an additional three-year fellowship. Along with Drs. Ellis and Ruthford, the team includes Lily Yu, MD, and Megan Sampson, DO, and three pediatric surgeons.
Ellis says each physician has not only mastered the foundational skills needed to care for sick or injured children, but also brings an additional, more nuanced, level of expertise that strengthens Sanford's overall ability to provide the best possible pediatric care.
"Dr. Ruthford and Dr. Sampson are geared toward education, for example," says Ellis. "They derive a lot of satisfaction from educating others on pediatric emergency medicine. Dr. Sampson has also had some administrative experience, which is unique. And Dr. Yu is very geared toward process improvement. How can we standardize our processes for the entire Sanford footprint?"
Dr. Ellis himself gravitates toward disaster training, likes teaching advanced practice providers, and has enjoyed watching the program grow as a part of Sanford's larger pediatric care ecosystem. "It has been great to work with the subspecialists and hospitalists to constantly be looking for ways to make our program better," he says.
Seamless Care in the ER and Beyond
But Sanford's response to pediatric emergencies doesn't end at the emergency room doors. In fact, Drs. Ellis and Ruthford and their partners are just the tip of a pediatric 'iceberg' that includes the entire Sanford Children's Hospital, conveniently adjacent to the ER.
"We have over 75 subspecialists at the Children's Hospital, so we have a huge breadth of knowledge right next door, including child life specialists," says Dr. Ellis. "If you are going to have a world class emergency medicine program, child life is a must. They are some of the busiest people in the hospital."
Child life specialists work with the providers to help children and families cope with medical emergencies. Ellis describes it as "stepping into the gap" so that the team can focus on the medical problem.
"They are available for consultation and they'll come explain what an IV is or how a CT scan or ultrasound works," says Dr. Ruthford. "They really help to make the whole experience less traumatic."
"One big part of what we do involves communication, not just with family, but also with the child," says Dr. Ellis. "Because, if a child has an understanding of what is happening, they are not only going to be more cooperative but they are going to have a better experience and a more effective experience."
Although the Sanford ER does not yet have 24/7 coverage with pediatric emergency specialists, Ruthford says there is at least one provider on hand most days and always between the hours of 4:00 pm and midnight. And the department is continually looking for ways to provide a more efficient experience.
"We are creating a fast track in the early afternoons when we tend to see more kids, so that those with less emergent complaints who don't need imaging or emergent procedures can be identified and brought to a specific area," says Dr. Ruthford. "We are definitely very busy and still evolving to see more pediatric patients."
Regardless of when a child comes in, Dr. Ellis says Sanford's emergency department is always geared toward children's needs and fully equipped to be the best starting point for a sick or injured child's healing journey.
"We are continuing to renovate the emergency department to make it ever more child friendly," he says. "It is our goal that, if you have a child with a significant injury or illness, Sanford will be the place to take them."
Alex Strauss is the Editor of MED and an award winning healthcare writer. Every MED cover story is based on personal interviews and research. Our thanks to Drs. Ellis and Ruthford for their time and expertise and to the Sanford Health marketing department for helping to bring this piece to life.