Pediatric Discharge From the Emergency Department Against Medical Advice

In this Ethics Rounds we present a conflict regarding discharge planning for a febrile infant in the emergency department. The physician believes discharge would be unsafe and would constitute a discharge against medical advice. The child’s mother believes her son has been through an already extensive and painful evaluation and would prefer to monitor her well-appearing son closely at home with a safety plan and a next-day outpatient visit. Commentators assess this case from the perspective of best interest, harm-benefit, conflict management, and nondiscriminatory care principles and prioritize a high-quality informed consent process. They characterize the formalization of discharge against medical advice as problematic. Pediatricians, a pediatric resident, ethicists, an attorney, and mediator provide a range of perspectives to inform ethically justifiable options and conflict resolution practices.

How we handled COVID crisis? Experience of an Indian tertiary level NICU

Background: Coronavirus disease (COVID-19) has imposed several challenges in clinical care. With rapid increase in the disease, there has been lot of incidences of COVID-19 positive exposure among the healthcare workers resulting in major crisis. Aim: The aim of the study was to emphasize various methods that can be used to manage COVID-19 crisis due to accidental exposure. Methods: An unprecedented exposure occurred to a COVID-19 positive healthcare worker in the Neonatal Intensive Care Unit (NICU), which led to quarantine of almost 90% of the primary staff. The methods undertaken included communication and continuation of clinical care through teleconsultation (video calling, zoom meetings for clinical decision, telecharting of daily prescription, and facilitating manpower from allied departments [only one pediatric resident each day], and restoration of services with come back). Results: There were total 11 babies at the time of exposure. Two babies were on respiratory support. The parents were counseled through teleconsultation. Nine babies could be discharged during quarantine period and there was no significant deterioration in the clinical condition of the two babies on respiratory support. All the babies were tested for COVID-19 as per post-exposure protocol and remained negative. Conclusion: With the help of teleconsultation and support from allied specialties and other health facilities, the crisis of COVID-19 exposure can be handled well.