scholarly journals Modelling the allocation of paediatric intensive care retrieval teams in England and Wales

2019 ◽  
Vol 104 (10) ◽  
pp. 962-966 ◽  
Author(s):  
Madeline King ◽  
Padmanabhan Ramnarayan ◽  
Sarah E Seaton ◽  
Christina Pagel
Keyword(s):  
Intensive Care ◽  
Optimal Allocation ◽  
Paediatric Intensive Care ◽  
Critically Ill Children ◽  
Supporting Evidence ◽  
England And Wales ◽  
Location Allocation ◽  
Current Location ◽  
National Quality ◽  
The Impact

BackgroundFollowing centralisation of UK paediatric intensive care units in 1997, specialist paediatric intensive care retrieval teams (PICRTs) were established to transport critically ill children from district general hospitals (DGHs). The current location and catchment area of PICRTs covering England and Wales are based on historical referral patterns. National quality standards specify that PICRTs should reach the patient bedside within 3 hours of accepting a referral.ObjectiveTo determine what proportion of demand for PICRT services in England and Wales can be reached within 3 hours and to explore the potential coverage impact of more stringent ‘time to bedside’ standards.MethodsWe used mathematical location–allocation methods to: (1) determine the optimal allocation of DGHs to current PICRT locations to minimise road journey time and calculated the proportion of demand reachable within 3 hours, 2 hours, 90 min, 75 min and 1 hour and (2) explore the impact of changing the number and location of PICRTs on demand coverage for the different time thresholds.ResultsFor current (and optimal) location of 11 PICRTs, 98% (98%) of demand is reachable within 3 hours; 86% (91%) within 2 hours; 59% (69%) within 90 min; 33% (39%) within 75 min; and 20% (20%) within 1 hour. Five hospitals were not reachable within 3 hours. For the 3-hour standard, eight optimally located PICRT locations had similar coverage as the current 11 locations.ConclusionsIf new evidence supports reduction in the time to bedside standard, many more hospitals will not be adequately covered. Location–allocation optimisation is a powerful technique for supporting evidence-based service configuration.

scholarly journals Epidemiology of Cardiopulmonary Resuscitation in Critically Ill Children Admitted to Pediatric Intensive Care Units Across England: A Multicenter Retrospective Cohort Study

2021 ◽  
Vol 10 (9) ◽  
Author(s):  
Khurram Mustafa ◽  
Hannah Buckley ◽  
Richard Feltbower ◽  
Ramesh Kumar ◽  
Barnaby R. Scholefield
Keyword(s):  
Intensive Care ◽  
Quality Improvement ◽  
Cardiopulmonary Resuscitation ◽  
Intensive Care Units ◽  
Retrospective Cohort ◽  
Pediatric Intensive Care ◽  
Paediatric Intensive Care ◽  
Critically Ill Children ◽  
Pediatric Intensive Care Units ◽  
National Quality

Background Cardiopulmonary arrests are a major contributor to mortality and morbidity in pediatric intensive care units (PICUs). Understanding the epidemiology and risk factors for CPR may inform national quality improvement initiatives. Methods and Results A retrospective cohort analysis using prospectively collected data from the Paediatric Intensive Care Audit Network database. The Paediatric Intensive Care Audit Network contains data on all PICU admissions in the United Kingdom. We identified children who received cardiopulmonary resuscitation (CPR) in 23 PICUs in England (2013–2017). Incidence rates of CPR and associated factors were analyzed. Logistic regression was used to estimate the size and precision of associations. Cumulative incidence of CPR was 2.2% for 68 114 admissions over 5 years with an incidence rate of 4.9 episodes/1000 bed days. Cardiovascular diagnosis (odds ratio [OR], 2.30; 95% CI, 2.02–2.61), age <1 year (OR, 1.84; 95% CI, 1.65–2.04), the Paediatric Index of Mortality 2 score on admission (OR, 1.045; 95% CI, 1.042–1.047) and longer length of stay (OR, 1.013; 95% CI, 1.012–1.014) were associated with increased odds of receiving CPR. We also found a higher risk of CPR associated with a history of preadmission cardiac arrest (OR, 20.69; [95% CI, 18.16–23.58) and for children with a cardiac condition admitted to a noncardiac PICU (OR, 2.75; 95% CI, 1.91–3.98). Children from Black (OR, 1.68; 95% CI, 1.36–2.07) and Asian (OR, 1.49; 95% CI, 1.28–1.74) racial/ethnic backgrounds were at higher risk of receiving CPR in PICU than White children. Conclusions Data from this first multicenter study from England provides a foundation for further research and evidence for benchmarking and quality improvement for prevention of cardiac arrests in PICU.

scholarly journals The effect of care provided by paediatric critical care transport teams on mortality of children transported to paediatric intensive care units in England and Wales: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah E. Seaton ◽  
◽  
Elizabeth S. Draper ◽  
Christina Pagel ◽  
Fatemah Rajah ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Critical Incidents ◽  
Paediatric Intensive Care ◽  
Junior Doctors ◽  
England And Wales ◽  
The Impact ◽  
Paediatric Critical Care ◽  
Paediatric Intensive Care Units

Abstract Background Centralisation of paediatric intensive care units (PICUs) has the increased the need for specialist paediatric critical care transport teams (PCCT) to transport critically ill children to PICU. We investigated the impact of care provided by PCCTs for children on mortality and other clinically important outcomes. Methods We analysed linked national data from the Paediatric Intensive Care Audit Network (PICANet) from children admitted to PICUs in England and Wales (2014–2016) to assess the impact of who led the child’s transport, whether prolonged stabilisation by the PCCT was detrimental and the impact of critical incidents during transport on patient outcome. We used logistic regression models to estimate the adjusted odds and probability of mortality within 30 days of admission to PICU (primary outcome) and negative binomial models to investigate length of stay (LOS) and length of invasive ventilation (LOV). Results The study included 9112 children transported to PICU. The most common diagnosis was respiratory problems; junior doctors led the PCCT in just over half of all transports; and the 30-day mortality was 7.1%. Transports led by Advanced Nurse Practitioners and Junior Doctors had similar outcomes (adjusted mortality ANP: 0.035 versus Junior Doctor: 0.038). Prolonged stabilisation by the PCCT was possibly associated with increased mortality (0.059, 95% CI: 0.040 to 0.079 versus short stabilisation 0.044, 95% CI: 0.039 to 0.048). Critical incidents involving the child increased the adjusted odds of mortality within 30 days (odds ratio: 3.07). Conclusions Variations in team composition between PCCTs appear to have little effect on patient outcomes. We believe differences in stabilisation approaches are due to residual confounding. Our finding that critical incidents were associated with worse outcomes indicates that safety during critical care transport is an important area for future quality improvement work.

scholarly journals G372 Prolonged invasive ventilation in paediatric intensive care: children resident in england and wales, 2004–2013

2015 ◽  
Vol 100 (Suppl 3) ◽  
pp. A152.2-A152
Author(s):  
SJ Fleming ◽  
CR Lamming ◽  
A Evans ◽  
KP Morris ◽  
ES Draper ◽  
...  
Keyword(s):  
Intensive Care ◽  
Paediatric Intensive Care ◽  
Invasive Ventilation ◽  
England And Wales

The rate and impact of substance misuse in psychiatric intensive care units (PICUs) in the UK

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Hattie Catherine Ann Moyes ◽  
Lana MacNaboe ◽  
Kate Townsend
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Substance Misuse ◽  
Well Being ◽  
Training Programme ◽  
Content Type ◽  
National Quality ◽  
Improvement Programme ◽  
The Uk ◽  
The Impact

Purpose This paper aims to understand the current scale of substance misuse in psychiatric intensive care units (PICUs), identify how substance misuse affects members of staff, patients and the running of wards and explore with staff what resources would be most useful to more effectively manage substance misuse and dual diagnosis on PICUs. Design/methodology/approach The paper used a mixed-methods approach, using a quantitative survey to determine the extent of substance use in PICUs and a co-design workshop to understand the impact of substance misuse on PICU wards, staff and patients. Findings The estimated rate of substance misuse in PICUs over a 12-month period is 67%, with cannabis the most frequently used substance. Despite the range of problems experienced on PICUs because of substance misuse, the availability of training and resources for staff was mixed. Research limitations/implications The findings may not be fully generalisable as research participants were members of a national quality improvement programme, and therefore, may not be representative of all PICUs. Data was collected from clinicians only; if patients were included, they might have provided another perspective on substance misuse on PICUs. Practical implications This paper emphasises the importance of substance misuse training for PICU staff to adequately respond to patients who misuse substances, improve the ward environment, staff well-being and patient outcomes. Originality/value This paper provides an updated estimation of rates of substance misuse in PICUs over a 12-month period and make suggestions for a training programme that can better support staff to address substance misuse on PICUs.

DOES CHLORHEXIDINE WIPE HELP IN REDUCING HOSPITAL ACQUIRED INFECTIONS (HAIS) AMONG CRITICALLY ILL CHILDREN ADMITTED TO A PAEDIATRIC INTENSIVE CARE UNIT?

2021 ◽  
pp. 35-37
Author(s):  
Madhan Kumar ◽  
Jolly Chandran ◽  
Pragathesh Pragathesh ◽  
Ebor Jacob Gnananayagam ◽  
Hema Paul ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Paediatric Intensive Care Unit ◽  
Paediatric Intensive Care ◽  
Critically Ill Children ◽  
Intervention Period ◽  
Hospital Acquired Infections ◽  
Hospital Acquired ◽  
Historical Controls

OBJECTIVE: To determine the effect of chlorhexidine wipes in reducing the incidence of hospital acquired infections (HAIs) among critically ill children admitted in Paediatric Intensive Care Unit (PICU). METHODS: An interventional study, wherein enrolled children were wiped with chlorhexidine after routine bath. The incidence of HAIs were noted and compared with data from historical controls of previous year during the same period (pre-intervention). RESULTS: One hundred and ninety nine children in the intervention period were compared with 271 children from pre-intervention period. The numbers of ventilator-days were 777 and 696 respectively for the intervention period and pre-intervention periods. Incidence of ventilator associated pneumonia (VAP) reduced from 12.9/1000 ventilator-days in the pre-intervention period to 6.4/1000 ventilator-days in the intervention period (p=0.1). VAP prevalence was 3.3% in the pre-intervention period as compared to 2.5% in the intervention period (p=0.6). The incidence of CLABSI was 3.6/1000 catheter-days (catheter days: 1377) with prevalence of 2.5% in the intervention period, whereas among the historic controls of the previous year it was 4.2/1000 days (catheter days 1432) with a prevalence of 2.2% (p= 0.8). No untoward effect was reported. CONCLUSION: The use of chlorhexidine wipes in ICU was feasible but did not signicantly decrease HAIs.

scholarly journals 2 Systemic glucocorticoids and bradycardia in critically ill children: a retrospective study

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e1-e1
Author(s):  
Camille Maltais-Bilodeau ◽  
Maryse Frenette ◽  
Geneviève Morissette ◽  
Dennis Bailey ◽  
Karine Cloutier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Heart Rate ◽  
Intensive Care ◽  
Retrospective Study ◽  
Critically Ill ◽  
Medical Staff ◽  
Pediatric Population ◽  
Critically Ill Children ◽  
Rate Variation ◽  
The Impact

Abstract Background Glucocorticoids are widely used in the pediatric population. They are associated with numerous side effects including repercussions on the cardiovascular system. The impact on heart rate is not well known, but bradycardia has been reported, mostly with high doses. Objectives We described the occurrence of bradycardias and the variation of heart rate in critically ill children receiving glucocorticoids. Design/Methods We conducted a retrospective study including 1 month old to 18 year old children admitted to the Pediatric Intensive Care Unit between 2014 and 2017, who received a glucocorticoid dose equivalent to 1 to 15 mg/kg/day of prednisone. We collected data on exposition to glucocorticoids, heart rate before, during and after the exposition, and interventions from the medical staff in response to bradycardia. The primary outcome was the occurrence of bradycardia and the secondary outcomes were the magnitude of heart rate variation and the clinical management of bradycardias. Results We included 92 admissions (85 patients). The median dose of glucocorticoid used was 2.80 mg/kg/day of prednisone (2.08—3.80). We found 70 cases (76%) with at least one bradycardia. Before treatment, all patients had a mean heart rate higher than the 5th percentile for age. During exposition to glucocorticoids, 8 patients (10%, n = 83) had a median heart rate ≤ 5th percentile. We noted 46 cases of bradycardia (50%) that led to an intervention from the medical staff, but no patient had a major event associated to bradycardia. We found a significant association between bradycardia and age (estimate -0.136, 95% CI -0.207—-0.065, p &lt; 0.001), glucocorticoid dose (estimate 4.820, 95% CI 2.048—7.592, p &lt; 0.001) and intravenous administration (estimate 8.709, 95% CI 1.893—15.524, p = 0.012). Conclusion In our study, most children hospitalized at the intensive care unit receiving standard doses of glucocorticoid experienced bradycardia. The majority of episodes led to an intervention from the medical staff. Presence of bradycardia was associated with younger age, higher dose and IV administration of glucocorticoids.

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