When the Novant Health pediatrics emergency room in Charlotte opened on July 27, 2003, Dr. Sara Steelman, a Midwesterner who’d moved to the South for this job, was there to work the very first shift in Charlotte’s first pediatric ER.
And as Novant Health Hemby Children’s Emergency Department celebrates 20 years of service to the community, she’s still here – treating young, often frightened, patients and leading a staff of eight physicians and numerous other providers. Steelman is the ER’s medical director, and in that role, she devotes half her time to patient care and half to her leadership role at the facility, located alongside the ER at Novant Health Presbyterian Medical Center.
“I will always remember my very first patient,” she once said in an interview. “It was a 3-year-old little boy with a case of diarrhea. I wish all our patient cases were that easy!”
She’s handled much more complex and critical cases since then.
“We see it all,” she said in discussing what brings patients to the ER. “Respiratory distress is one of the most common reasons a child comes to the emergency department.” Cases of R.S.V. (respiratory syncytial virus) – a common and usually mild condition that can be severe in infants and the elderly – grew so much last winter that the New York Times wrote that it was overwhelming pediatric units across the United States.
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Steelman points out one key differentiator between the Novant Health Hemby Children’s Hospital ER and most other ERs: “We have access to respiratory therapists who are exclusively dedicated to pediatric patients.”
Some of the tougher cases: “We see cases of SIDS (Sudden Infant Death Syndrome), which is always sad.” Given the severity of some illnesses and injuries they treat, the staff in a pediatric ER has to become adept at compartmentalizing, Steelman said. “Still,” she added, “there are some cases that haunt you.”
Steelman is so skilled at interacting with children that it comes as a surprise to learn she didn’t always want to be a pediatrician – or in medicine at all. She went to college with the intention of majoring in piano performance. But then she took a biology class, and it changed everything. “I loved this class, which led me to change the course of my studies,” she once explained. “And in my junior year, I decided to go into medicine. It was the best of both worlds as it was based in the sciences and involved working with people.”
Kid-friendly in every way
When Steelman first opened Novant Health’s pediatric ER, few hospitals in the country had dedicated ERs just for kids. They’ve become more common over the past two decades; as of 2019, there were more than 250 in the United States. They’re still not widespread, though, considering the U.S. has more than 6,100 hospitals.
The biggest change Steelman has seen in 20 years is how much busier the ER has gotten. Aside from the COVID years, the annual increase in ER patients had been steady. By 2010, the pediatrics ER had outgrown its old space and moved to a bigger one. The original ER had eight beds; the current one has 14.
Another change – one Steelman laments – is the volume of young patients coming to the ER with mental health struggles. “We always wish we could do more for them,” she said.
It’s a sentiment echoed by her colleague, Dr. J.R. Young, who joined the staff in 2017. “The need for pediatric behavioral health care has grown exponentially,” he said. “It’s been a huge practice shift. Sometimes, our behavioral health patients number in the double digits per day.”
Young attributes some of the rise in psychological issues in children and teens to fragile family structures. But, he adds, “Much of it can be traced back to social media. Depression, anxiety and suicidal ideation are often related to smartphones and peer pressure coming through the social media kids consume.”
Steelman adds: “It’s a nationwide problem – and one that predates COVID by several years. We do our best to place patients as soon as we can, but it’s a very pressing problem.”
When a child is having a mental health crisis, the ER is the right place for them, Steelman said. She only wishes help were more immediately available.
While Young hasn’t been with the pediatric ER as long as Steelman, he has seen changes during his tenure. “We used to be more of a community ER, but we’ve become a tertiary care ER,” he said. (Tertiary care refers to subspecialty care, such as pediatric cardiology, pulmonology or neurosurgery.) “We get many more complicated cases now. We used not to see so many different underlying health issues or pulmonary problems and so on. Consequently, we’ve become a much more robust pediatric center.”
The main difference in the pediatric ER and general ERs, Steelman said, is the level of specialization the clinical staff has. The doctors are specialty trained in pediatric emergency medicine, and the nurses have further training in pediatric emergency care, as well. In addition, child life specialists help alleviate kids’ (and parents’) anxiety and fear. Besides that, the pediatric ER is kid-friendly by design. The rooms are even decorated in a child-friendly way.
“Having a separate children’s emergency room is a real satisfier for parents,” Steelman said, comparing it to a general ER, where the sights and sounds can be a lot for young patients to process. “One of our aims is to make an already traumatic experience much less scary for the child and the parent.”
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‘One and done’
Steelman said she’s reminded daily that she chose the right career. “I love taking care of children,” she said. “I love helping parents understand what’s going on with their child. It’s especially satisfying when a parent has been really worrying about something that turns out to be easy to fix.”
She also loves the “one-and-done” nature of her work. “I like the neatness of it,” she said. “In the ER, we can see, diagnose and fix a problem in one visit. We wrap it up and send patients on their way and in good shape. You feel like you’ve intervened and made a difference in a pretty short period of time.”
The fast pace of emergency medicine also appeals to her.
Her love of her work is evident to those around her. “Pediatric care is near and dear to her heart,” Young said. “She’s a fabulous, visionary leader who’s been willing to push boundaries in order to serve the needs of the families who need us.”
“She is decisive and very smart and … able to help parents make good medical decisions in a rapid fashion,” he added. “She emphasizes providing appropriate, comforting measures and care for the parent, too. Part of our job in caring for children is making sure their parents are comfortable with the plan.”
The pediatric ER is a great place to work, Young said – and that’s directly related to Steelman’s leadership. “There’s great camaraderie in our department,” he said. “And there's a nice feeling in knowing that you put forth your best effort and you, hopefully, made an impact that can help this kid or this family avoid returning to the ER.”
More pediatric subspecialists
In reflecting on 20 years of leading the pediatric ER, Steelman feels a sense of pride in whatever way the pediatric ER has contributed to Novant Health’s increased number of pediatric subspecialties.
“We don’t want to take any credit,” she said. “But Novant Health has seen a really robust increase in pediatric subspecialists since the ER opened 20 years ago. There were very few when we first opened.” Now, there are specialists in childhood cancer, cardiology, endocrinology, neurology, urology, sleep, breathing issues, allergies, teen health and more.
But when a lot of these young patients are having a crisis, or even just a scary moment, Steelman will be the first doctor they see.
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