Improved outcomes from tertiary center pediatric intensive care

Pollack, Murray M.; Alexander, Steven R.; Clarke, Nancy G.; Ruttimann, Urs E.; Tesselaar, Helen M.; Bachulis, Antoinet C.

doi:10.1097/00003246-199102000-00007

Cited by 297 publications

(12 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The practice of centralising paediatric intensive care services, specifically, has been associated with lower mortality rates and costs. [3][4][5][6] These intensive care units are able to provide high-quality care due to their familiarity with the management of seriously ill children. [7] Children admitted to PICUs in SA have been shown to differ substantially from those in developed countries, tending to be younger and requiring management of infective illnesses.…”

Section: Articlementioning

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: Articlementioning

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

“…[8,9] Critically ill children have a higher mortality rate when cared for in mixed units; well-established models from developed countries show better outcomes in children when centralised paediatric critical care and retrieval services are available. [12,13] However, data on the implementation of these models in low-or middleincome countries are lacking. [14] In addition, the transport of critically ill children to a tertiary paediatric intensive care unit (PICU) also poses a challenge, with a high incidence of adverse transfer-related events shown in a recent study in Cape Town.…”

Section: Researchmentioning

confidence: 99%

An assessment of critically ill children admitted to a general high-care unit in a regional hospital in Western Cape, South Africa

Vosloo

Breytenbach²,

Salie

2020

S Afr J CH

View full text Add to dashboard Cite

“…Such local management has advantages: it avoids the risks associated with transport; it reduces dislocation from family and community; and it relieves pressure on PICU services [7]. However, there may also be disadvantages: research suggests that children have better outcomes when treated in paediatric focused facilities rather than general intensive care services [8,9]. …”

Section: Introductionmentioning

confidence: 99%

The availability, spatial accessibility, service utilisation and retrieval cost of paediatric intensive care services for children in rural, regional and remote Queensland: study protocol

Thompson

Armfield

Slater

et al. 2013

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundSpecialist health services are often organised on a regionalised basis whereby clinical resources and expertise are concentrated in areas of high population. Through a high volume caseload, regionalised facilities may provide improved clinical outcomes for patients. In some cases, regionalisation may be the only economically viable way to organise specialist care. While regionalisation may have benefits, it may also disadvantage some population groups, particularly in circumstances where distance and time are impediments to access.Queensland is a large Australian state with a distributed population. Providing equitable access to specialist healthcare services to the population is challenging. Specialist care for critically ill or injured children is provided by the Queensland Paediatric Intensive Care Service which comprises two tertiary paediatric intensive care units. The two units are located 6 km (3.7 miles) apart by road in the state capital of Brisbane and provide state-wide telephone advice and specialist retrieval services. Services also extend into the northern area of the adjacent state of New South Wales. In some cases children may be managed locally in adult intensive care units in regional hospitals.The aim of this study is to describe the effect of geography and service organisation for children who need intensive care services but who present outside of metropolitan centres in Queensland.Methods/designUsing health services and population data, the availability and spatial accessibility to paediatric intensive care services will be analysed. Retrieval utilisation and the associated costs to the health service will be analysed to provide an indication of service utilisation by non-metropolitan patients.DiscussionWhile the regionalisation or centralisation of specialist services is recognised as an economical way to provide specialist health services, the extent to which these models serve critically ill children who live some distance from tertiary care has not been described. This study will provide new information on the effect of the regionalisation of specialist healthcare for critically ill children in Queensland and will have relevance to other regionalised health services. This study, which is focussed on describing the organisation, supply and demands on the health service, will provide the foundation for future work to explore clinical outcomes for non-metropolitan children who require intensive care.

show abstract

Improved outcomes from tertiary center pediatric intensive care

Cited by 297 publications

References 0 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

An assessment of critically ill children admitted to a general high-care unit in a regional hospital in Western Cape, South Africa

The availability, spatial accessibility, service utilisation and retrieval cost of paediatric intensive care services for children in rural, regional and remote Queensland: study protocol

Contact Info

Product

Resources

About