Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study

Ramnarayan, Padmanabhan; Thiru, Krish; Parslow, Roger C; Harrison, David A; Draper, Elizabeth S; Rowan, Kathy

doi:10.1016/s0140-6736(10)61113-0

Cited by 156 publications

(126 citation statements)

References 25 publications

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…Evidence from the developed world confirms the value of a specialised transfer process that includes the appropriate pre-and intratransfer care provided by specialised staff. [15,16] This study was conducted in a health service without specialised transfer teams and in a context characterised by unstable children, high pretransfer mortality, prolonged transfer time and high rates of adverse events in transit.…”

Section: Discussionmentioning

confidence: 99%

A retrospective review of the transfer of critically ill children to tertiary care in KwaZulu-Natal, South Africa

Royal

McKerrow

2015

S Afr J CH

View full text Add to dashboard Cite

Background.Obtaining care for an acutely ill child in specialised paediatric services relies on referral from lower-level facilities. In South Africa, it is common practice for acutely ill children to be transported far distances by non-specialist teams with limited equipment, knowledge and skills. Objectives. To describe the transfer of these children and to determine whether they deteriorate from the time of referral to the time of arrival at a tertiary centre. Furthermore, we sought to identify modifiable factors that might improve outcomes during resuscitation and transfer. Methods. The study was a retrospective review of emergency referrals of children aged 1 month -12 years to Grey's Hospital paediatric ward or paediatric intensive care unit (PICU), from lower-level facilities in KwaZulu-Natal between January and June 2012. In conjunction with an assessment by the receiving clinician at Grey's Hospital, Triage Early Warning Signs (TEWS) scores were obtained during telephonic referral and compared with the TEWS score on arrival in order to determine if a deterioration had occurred. Results. A total of 57 PICU referrals and 79 ward referrals were analysed. The mortality rate prior to transportation was 8.8%. Mean transfer distance was 131 km and mean transfer time 9 hours. Advanced life support teams undertook transportation in 76.7% of PICU and 25% of ward transfers and few adverse events were reported in transfer logs. However, 31.5% of PICU and 11.3% of ward referrals required immediate resuscitation on arrival. When the TEWS scoring system was applied 78.5% of PICU and 30.4% of ward referrals fell into the 'very urgent' and 'emergency' categories. Conclusion. Pretransport and in-transit care failed to stabilise children and this may reflect lack of skill of attending healthcare workers, transport delays or illness progression. Interventions to improve resuscitation and transfer are needed, and the use of retrieval teams should be investigated.

show abstract

Section: Discussionmentioning

confidence: 99%

A retrospective review of the transfer of critically ill children to tertiary care in KwaZulu-Natal, South Africa

Royal

McKerrow

2015

S Afr J CH

View full text Add to dashboard Cite

show abstract

“…Specific pediatric units are desirable if the turnover rate justifies such a unit and warrants expertise. Whenever possible pediatric patients should be treated in specialized pediatric ICUs [8].…”

Section: Recommendations-part I: Operational Guidelinesmentioning

confidence: 99%

Recommendations on basic requirements for intensive care units: structural and organizational aspects

Valentin

Ferdinande²

2011

Intensive Care Med

291

170

View full text Add to dashboard Cite

show abstract

“…The clinical risks may be controlled through well-organised ICU co-ordination and retrieval systems, already seen in paediatric critical care practice [13], but adult case volumes are higher and patterns of demand more complex. In practice, there are potential barriers to implementation [14], and a scarcity of evidence that reconfiguration of intensive care services improves outcomes in isolation.…”

Section: Should Regional Icus Be a Primary Goal?mentioning

confidence: 99%

Regionalisation of critical care: can we sustain an intensive care unit in every hospital?

Suntharalingam

Handy

Walsh³

2014

Anaesthesia

View full text Add to dashboard Cite

Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study

Cited by 156 publications

References 25 publications

A retrospective review of the transfer of critically ill children to tertiary care in KwaZulu-Natal, South Africa

A retrospective review of the transfer of critically ill children to tertiary care in KwaZulu-Natal, South Africa

Recommendations on basic requirements for intensive care units: structural and organizational aspects

Regionalisation of critical care: can we sustain an intensive care unit in every hospital?

Contact Info

Product

Resources

About