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Improving Pediatric Temperature Measurement in the ED
Beth Hurwitz1, Joanne Brown, Gerry Altmiller
1Beth Hurwitz is a staff nurse at Einstein Medical Center and Joanne Brown is a staff nurse at Einstein Healthcare Network, both in Philadelphia. Gerry Altmiller is a clinical nurse specialist consultant at Einstein Healthcare Network and an associate professor at the College of New Jersey in Ewing Township. Contact author: Beth Hurwitz, bkriegerrn@comcast.net. The authors have disclosed no potential conflicts of interest, financial or otherwise.
Insights
Temporal artery thermometry is an accurate and preferred method for measuring pediatric temperature in emergency departments. This noninvasive technique improves patient satisfaction and streamlines the triage process compared to traditional rectal measurements.
Area of Science:
- Pediatric emergency medicine
- Clinical quality improvement
- Evidence-based practice
Background:
- Debate exists among emergency department (ED) providers regarding optimal pediatric temperature measurement methods.
- Rectal temperature measurement, while accurate, causes distress and increases triage time for pediatric patients.
- Previous studies have examined temporal artery, tympanic membrane, axillary, and infrared methods.
Purpose of the Study:
- To determine the best practice for accurate temperature measurement in children under five years old in the ED.
- To evaluate alternative, less invasive methods to rectal thermometry.
Main Methods:
- An evidence-based quality improvement project was conducted by ED staff nurses.
- Included an exhaustive literature search and review of relevant studies.
- Developed a table of evidence and presented findings to recommend practice change.
Main Results:
- Temporal artery thermometry was adopted as the preferred practice.
- This noninvasive method provided consistently accurate temperature measurements.
- Observed increased patient and nurse satisfaction and a shorter triage process.
Conclusions:
- Temporal artery thermometry is a suitable, accurate, and preferred alternative to rectal thermometry in pediatric ED settings.
- Implementation of this method enhances patient experience and operational efficiency.
Overview:
ED care providers have long debated which of the various methods of temperature measurement of pediatric patients is best. While the efficacy and accuracy of temporal artery, tympanic membrane, axillary, and infrared temperature measurement have been studied, the gold standard has been rectal temperature measurement. But despite its accuracy, this method causes children with noninfectious complaints and their families unnecessary distress and adds significant time to the triage process. In response, a group of ED staff nurses at a multihospital health system conducted an evidence-based quality improvement project to determine the best practice for accurate temperature measurement in children younger than five years who presented to the ED. The project included an exhaustive literature search, a review of relevant studies, the development of a table of evidence, a presentation of the findings, and recommendations for practice change. This article describes the project and the adoption of temporal artery thermometry, a painless, noninvasive screening method that provided consistently accurate temperature measurement as well as increased patient and nurse satisfaction and a shorter triage process.
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