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The hospitalized child is a protagonist of a health project that goes beyond the prevention, diagnosis, treatment and rehabilitation of his/her disease, and puts the child at the center of research and care designed for the period from conception to adulthood.
The Maternal/Newborn department, with its specialized team of professionals and its dedicated structure, intervenes from conception to delivery (obstetrics and gynecology), in the delicate neonatal period (Neonatology and Neonatal Intensive Care), and in the years between infancy and adulthood (Pediatrics, Pediatric Surgery, Pediatric and Adolescent Neuropsychiatry, Pediatric Eye Surgery).
PEDIATRIC EMERGENCY ROOM (ER)
> When should a child be brought to the ER?
When his/her health status indicates an acute illness during the hours and days in which the child’s pediatrician is not in service. If the child’s life is in danger, or if immediate medical assistance is needed, call 118.
In the North Area, Block DEA (Emergency and Acceptance Dept.) there is the Paediatric Emergency Room where there is a waiting area to give acceptance to the youngest with some toys available. To this structure will be admitted patients with a green and white code assignment, while the more urgent cases (yellow and red code) will be managed by the ER staff.
> Who will give the acceptance?
Experienced nurse staff will provide to the identification procedures, will effectuate a first symptoms and general condition evaluation and will assign the triage codes. The next step is the visit carried out by the paediatrician.
> What is the priority code?
It is a four color code which classifies the gravity of the problem of patients who arrive in the ER
- Code red: absolute priority, life-threatening situation. The patient is admitted and stabilized. Other patients are informed of the resulting prolonged waiting period.
- Code yellow: serious pathology. The patient will be visited as soon as possible.
- Code green; treatment can wait. Patients with this code will be seen after the more serious cases.
- Code white: non-emergency situations that could be treated by the family doctor. Patients with this code will be seen only after all the other patients have been treated. If the code white status is confirmed by the visiting physician, all ER services (including diagnostic studies) are subject to an established fee, except in cases of exemption.
> Where do I have to bring the child for an ER visit?
To the DEA pavilion (Department of Emergency and Admission, Nuovo Pronto Soccorso) where a specialiozed waiting area has been created for children. Children who arrive in the ER and are assigned a code green or a code white will be accompanied to the pediatric department, where he/she will be visited by a pediatrician.
HOSPITALIZATION
> When is it indicated?
When it is determined that the child’s health cannot be improved with ambulatory care.
With the view of having a scheduled operation done, the hospitalization could be preceded by the pre-admission, that is a totally free health benefit that has the purpose of focusing every exam and every visit needed for the operation, in one or two outpatient accesses and it will be also included an anaesthetist counselling. That is made to avoid long term hospitalization.
> How does hospitalisation occur?
The physician who visits the child, either in the ambulatory care clinic or in the ER, after consulting with the child’s pediatrician, admits the child.
> What documents are needed?
For Italian citizens
- Identification card
- Regional card of services (Carta Regionale dei Servizi) or Health Card and Social Security Number (Tessera Sanitaria and Codice Fiscale)
For European Community citizens
- Identification card
- Form E 112 or European Health Card
For citizens of countries outside the European Community
- Permission of stay
- Health card or insurance policy or STP code
- Identification card
It is useful to bring all clinical documentation, and to communicate with the doctors at the moment of arrival in the department the names of the drugs which the child is using and current therapies. The doctor may decide to retain some documents, which will be returned at the moment of discharge.
> Who works in the department?
The doctor always is the reference point for the clinical pathway and for the information about the health condition and disease evolution. Nurses are in charge for the assistance and they provide to the patient care guaranteeing a global assistance, from the therapy administration to the taking care of the primary needs as hygiene, feeding, rest, etc. Therapists are in charge of the patient mobilization in the ambit of the rehabilitation programme and the support staff is in charge for the beverage and meals distribution and for patient accompaniment/transportation.
Each operator is identifiable by her/his identification card.
It is important to learn to identify them to let them operate in the best and in the proper way and moment.
> Where does admission take place?
In the pediatric department, either medical or surgical. Air-conditioned rooms for 1 to 2 patients with fold-away beds for parents are available. There are 5 isolation rooms for patients with infectios diseases.
DAY-HOSPITAL AND DAY SURGERY
> What is day-hospital (DH)?
It is a scheduled hospital admission that lasts 1 day, generally from 7 a.m. to 5 p.m., for diagnostic tests or treatment, including surgery (day- surgery, DS). This allows the child to go home at night, even if additional admissions are necessary, which may or may not be consecutive.
> When is DH scheduled?
When the condition of the child requires exams or therapies which cannot be done in the ambulatory clinic or at home.
> Where does DH or DS take place?
Day-hospital is located in the pediatric and childhood and adolescent neuropsychiatry department. Day-surgery is located in the pediatric surgery and pediatric eye surgery department.
AMBULATORY CARE CLINICS
> Which outpatient clinics are dedicated to children?
There are various clinics dedicated to children.
First visit can be booked:
Regional reservation free-toll number
800.638.638
mon-sat: 8 am-8 pm
Niguarda front office/window ticket
South Area/South Block
mon-fri: 8 am-7.0 pm
sat: 8 am 1 pm
Front office staff will communicate the date and time of the appointment, the cost, the way of payment and any preparation needed for the exam or visit to be done. It is helpful to communicate any special needs. The hospital guarantees the care of a specialist but not of a particular doctor. You can also book an appointment at the walk up window of the outpatient clinic.
> What must be brought to book a visit or exam?
- The doctor’s order for the visit from the child’s pediatrician or the family general practitioner, except for visits in the following departments: Obstetrics, General Pediatrics and Pediatric Neuropsychiatry, which have a direct access policy.
- Health Card or policy or regional code for Foreigner Temporary resent - S.T.P. (Straniero Temporaneamente Presente) for non-EC children.
- Before entering the ambulatory care clinics it is usually necessary to stop at the admittance office (Accettazione amministrativa) in the clinic building
> Is a doctor’s order always needed?
Yes in most cases. However, emergency and non-emergency visits in the following clinics can occur on a direct access basis (within the limits of people who haven’t chose the family paediatrician yet: Obstetric and gynecology, neonatology, Pediatrics, Psychiatry, pediatric neuropsychiatry, Eye Surgery (only for eyesight evaluation).
> What to do during the visit?
The waiting before a visit must be serenely. In the Paediatric Department and Outpatients Clinic we organized comfortable places with peaceful and relaxing moments with the support of ABIO association volunteers.
> Are children exempt from paying the fees?
No payment is due in the following cases:
- Exemption based on income
- Exemption based on patient age under 14 years
- Exemption based on disease
In the case of exemption, one must still stop at the admittance office (accettazione amministrativa)
> How are children made to feel at ease in the hospital?
Hospitalization or visit can be times of anxiety for a child. The personnel, with the help of the child parents, is very attentive to reassure the child. The pediatric nurse will greet the child with a smile, and toys and stuffed animals are available to distract him/her.
The pediatric department and ambulatory clinics have play rooms designed to create a calm and reassuring environment for children who are waiting for a visit or exam. The volunteers from the Association for the Child in the Hospital (ABIO) provides support and games to help relax and distract the young patients. If a problem arises that upsets the comfort in these waiting areas, the head nurse or volunteers should be notified.
> What about during hospitalisation?
The staff dos everything possible to room children together, based on age and disease. Parents can remain with the children to make them feel as much at home as possible.
> What should be brought to the hospital?
We advise you to bring comfortable clothes, pyjamas and sweatsuits.
> How do the children pass the time?
Every patient room has a television. There are two rooms for recreational and educational activities offered by the volunteers of ABIO and four teachers.
The volunteers of ABIO are highly motivated and specially trained to help children to pass time in the hospital. On certain days of the week “Doctor Smile”, a clown dressed like a doctor, visits the department to help the young patients and their family members by making them smile.
> What about school?
For school aged patients there is a school room open every day. In the afternoon, teachers are present, who contact the patients school to guarantee the program continuity.
> What about food?
Generally, the patient’s habit are respected. Staff is available for any special need. Breakfast is served around 7.30 a.m., followed by lunch, nap time and a snack. After dinner, around 9.30 p.m., silence and rest for the children is encouraged. A refrigerator is available to store the patient’s favourite foods. It is important to notify the head nurse and follow any dietary restrictions indicated by the doctors.
If the patient is under 12 months old, meals are free for the accompanying adult.
> Who should be asked for information regarding the child’s health status?
Generally, the doctors visits are in the morning, and follow the routine of the department. It is important not to hesitate to ask if something is not clear. The hours for meetings with the doctors are posted in every department. The nursing staff will visit to the patient room throughout the day to verify patient needs and perform ordered therapy.
> What documentation will be given on discharge?
The physician who is responsible for your discharge will prepare and give you a discharge letter, which summarizes the care given during hospitalisation. A summary of nursing care is also given. Both reports are addressed to your family doctor. They contain a description of your current health status, doctors’ orders for home, and an appointment for a follow-up visit.
> How can clinical documentation be obtained?
A copy of all clinical documentation regarding a hospitalization or previous access to the hospital can be requested at any time from the Clinical Chart Archives (Ufficio Cartelle Cliniche).
The request must be made in person by a parent.
In order to provide a substantial savings to the public, currently only for neuroradiological exams, image documentation is normally given on a CD-ROM, but traditional film prints are available on request.
Ufficio Cartelle Cliniche/Clinical documentation and case history office
Entrance Area, Pav. 1
tel. 02 6444.2212
fax 02 6444.3128
mon-fri: 8 am-1 pm/2 pm-4 pm
front office mon-fri: 9 am-1 pm
certificazionisanitarie@ospedaleniguarda.it
The discharge report and any other possible documentation (ER report, outpatients report, exam report) can be displayed on line with a protected access to parents or tutor resident in Lombardy and by the family paediatrician if the procedure of the Regional Health Service Card has been activated at the ASL.
> Some advice
We advise visitors not to bring valuables or large sums of money.
We remind you that smoking is not allowed in the hospital.
Cellular phones are allowed in most departments. Use of cellular phones must not interfere with the patients’ rest and departments’ routine.
At the moment of discharge, remember to pick up clinical documentation and personal medicines which had been turned in on admission.
> What services are available?
SERVICES AND FACILITIES
- Bar, self-service and shops
There are 3 bars (Entrance Area - Pav. 1, South Area, South Block, Central Area - Pav. 12), 1 self-service (South Area, South Block).
Shopping Gallery in the South Area – South Block.
- Bank
It is sited at the entrance Area, Pav. 1, ground floor.
There are 3 ATM: Entrance Area - Pav. 1, Central Area - Pav. 12 and South Area – South Block.
- Barber shop
Based on patient needs, the charge nurse can ask for the barber. This service is with fee.
- Laundry
In case of need, Unione Samaritana volunteers offer a laundry and wardrobe free service. To make use of this service it is useful to ask information to the charge nurse.
- Accommodation
Patient’s relatives or patient in a day hospital regime coming from other towns can make use of accommodations with favourable fee.
SERVICES ON SUPPORT TO PATIENT AND FAMILY
- Animation
For the youngest patients we have areas dedicated as recreation rooms sited in the Paediatric Department. Moreover A.B.I.O. (Children in Hospital Association) volunteers are present for entertain children.
Cultural mediators and interpreters
For foreigners patients, the charge nurse will ask for the intervention of the interpreter or of the cultural mediator.
- School
For patients at school age it will be guarantee the education continuity. In the Paediatric Department there are qualified teachers which follows the young patients in the afternoons in equipped classrooms. In the Spinal Unit teachers are available to guarantee the education continuity until the first two years of high school.
- Social Services
The activity is dedicated to hospitalized people, for outpatient people and for day hospital. It offers consultancy and information about health and territorial social services, about residential structures, disability procedures, prosthesis supply, hospitality for relatives coming from other towns and information about the in force rules in the health and social field. Moreover it deals for the care of the patient with malaise or in an uncomfortable psycho-social situation to plan personalized intervention (continuity of care, housing with the support of the social services, social integration or integration in specialized structures, support to difficult maternity situations, safeguard of the newborn and child).
- Voluntary
In the Department work some voluntary associations as: Unione Samaritana, Associazioni Volontari Ospedalieri and A.B.I.O.. Volunteers offer support and strong help for moral support. Our hospital complies with the Rights Chart for Children promoted by A.B.I.O. Association.
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