Children’s intensive care under increased pressure, although mortality remains low

Posted by pt91 at Nov 02, 2017 10:14 AM |
Report co-authored by University of Leicester academic

Issued by University of Leicester on 2 November

  • Embargoed audio news clips from the authors available from Wednesday morning. Download audio from Professor Elizabeth Draper (University of Leicester) here and Dr Roger Parslow here

Paediatric intensive care units in the UK and Ireland were operating under increased pressure as they coped with rising numbers of patients and a lack of specialist nurses, according to the latest audit of services.

Many units failed to meet the minimum nursing levels recommended by the UK Paediatric Intensive Care Society.

Despite the pressures, only a small number of children died while in intensive care, less than four per cent, and that figure has remained stable over recent years indicating clinical standards were being maintained. Indeed, this figure has reduced since 2003-2004 when the rate was 5.5%.

The picture of a system under strain emerged from the latest annual report from the Paediatric Intensive Care Audit Network (PICANet) – a collaboration between the Universities of Leeds and Leicester commissioned by the Healthcare Quality Improvement Partnership (HQIP) to promote high-quality clinical care.

The audit received data from 34 paediatric intensive care units and 11 specialist critical care transport organisations across the UK and Ireland. The figures relate to 2016.

The findings showed that 20,231 children were admitted to a specialist intensive care unit last year – a slight rise on the figure for the previous year, continuing a trend identified over recent years. Some of the rise in caseload may have been due to an increased birth rate.

The audit team asked the units to provide details of the number of qualified nursing staff on duty at four time points during November 2016.

The recommended standard set by the UK Paediatric Intensive Care Society was to have seven whole-time equivalent nurses for each occupied bed. However many PICUs failed to meet this target.

Just over half the units were able to meet the standard during normal working hours – that slipped at night and at weekends, with just a third having the required level of qualified staff on duty at midnight on a Sunday.

Some units were operating with levels of occupancy above the good-practice guideline of 80%. Across England, the occupancy rate was of 95 per cent. In Wales it was 100 per cent. The figures were slightly lower in Scotland and the Republic of Ireland – 85 per cent.

Professor Elizabeth Draper, co-author from the University of Leicester, said:  “Occupancy levels in paediatric intensive care are very high and from our census, at best, only around half of units met the recommended nurse to patient ratio.

“This is particularly the case in London where bank and agency staff are needed to keep units running. The reliance on agency staff raises questions about the continuity of care, particularly if the nurses are not familiar with the unit they’re working on.

“This information is being fed into the current Paediatric Critical Care Review in order to facilitate future planning of paediatric intensive care services.”

The health care regulator in England, the Care Quality Commission, said when a decision is made that a child needs intensive care, the specialist critical care team providing transport should be mobilised within an hour.

The audit revealed that did not happen in one in four cases.

The audit revealed there were 12,672 specialist transfers.  In 2,471 of those, it took between 1 and 3 hours to mobilise the transport team and in a further 906 cases, the mobilisation took more than 3 hours.

Delays were caused by both the availability of specialist critical care transport teams and the fact that beds were not always available.

Co-author of the audit report, Dr Roger Parslow from the School of Medicine at the University of Leeds, said: “Last year we highlighted the number of referrals to paediatric intensive care that were not actioned, with two thirds being refused as there was no staffed bed available and we see a similar situation this year.

“When specialist transport teams do accept a referral, 30% of the journeys do not start within the hour, a standard set by the Care Quality Commission.

“The whole picture is one of a service under pressure so it is a credit to those working in paediatric intensive care that mortality continues to remain low and children remain well cared for.”

FURTHER INFORMATION

A copy of the embargoed report and appendix and audio clips can be downloaded here

(https://drive.google.com/open?id=0B691WmQZab8LT1VGSmJVUGxFLWs)

Download an audio clip from Professor Elizabeth Draper (University of Leicester) here

Contact: David Lewis, University of Leeds Press Office: Tel +44 (0)113 34 38059, email d.lewis@leeds.ac.uk

PICANet has been collecting data on all admissions to paediatric intensive care in England and Wales since 2002 and has expanded to include two units in Scotland, one in Northern Ireland, two in the Republic of Ireland and two private PICUs in London. It currently holds data on over 280,000 admissions.  The information held on the PICANet database has been used by the Department of Health, strategic health authorities, commissioners, clinical audit teams, researchers and individual institutions to improve the delivery of paediatric intensive care.

This fourteenth annual report from PICANet on activity and outcomes in paediatric intensive care services in the UK and Ireland, includes details of past, present and future clinical trials involving PICANet data for driving quality improvement through research and clinical trials as well as providing information for commissioning and service development. The report is available to download free here: www.picanet.org.uk.

PICANet is commissioned through the Healthcare Quality Improvement Partnership (HQIP) and the National Clinical Audit Programme* and also administered by the Welsh Health Specialised Services Committee; NHS Lothian/National Service Division NHS Scotland; the Royal Belfast Hospital for Sick Children; National Office of Clinical Audit Ireland (NOCA) and HCA International.

The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement in patient outcomes, and in particular, to increase the impact that clinical audit, outcome review programmes and registries have on healthcare quality in England and Wales. HQIP holds the contract to commission, manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations and crown dependencies. www.hqip.org.uk/national-programmes

University of Leeds

The University of Leeds is one of the largest higher education institutions in the UK, with more than 33,000 students from more than 150 different countries, and a member of the Russell Group of research-intensive universities.

We are a top 10 university for research and impact power in the UK, according to the 2014 Research Excellence Framework, and in the top 100 for academic reputation in the QS World University Rankings 2018. Additionally, the University was awarded a Gold rating by the Government’s Teaching Excellence Framework in 2017, recognising its ‘consistently outstanding’ teaching and learning provision. Twenty-four of our academics have been awarded National Teaching Fellowships – more than any other institution in England, Northern Ireland and Wales – reflecting the excellence of our teaching.  www.leeds.ac.uk

University of Leicester

The University of Leicester is led by discovery and innovation – an international centre for excellence renowned for research, teaching and broadening access to higher education. It is among the top 25 universities in the Times Higher Education REF Research Power rankings with 75% of research adjudged to be internationally excellent with wide-ranging impacts on society, health, culture, and the environment. Find out more: https://le.ac.uk/about-us

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