Increasing admissions to paediatric intensive care units in England and Wales: more than just rising a birth rate

Davis, Peter J.; Stutchfield, Christopher; Evans, T Alun; Draper, Elizabeth S

doi:10.1136/archdischild-2017-313915

Cited by 25 publications

(26 citation statements)

References 28 publications

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“…What are the potential implications of this study for PIC and paediatrics? Combined with population growth and increasing demand for PICU,1 increasing long-stay patient admissions may have a significant impact on PICU capacity, efficiency and throughput. If these findings are verified across other PICUs, the implications for future critical care planning are considerable.…”

Section: Discussionmentioning

confidence: 99%

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Trends in long-stay admissions to a UK paediatric intensive care unit

et al. 2019

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ObjectiveProlonged admission to a paediatric intensive care unit (PICU) consumes significant healthcare resource. An increase in the number of long-stay admissions and bed utilisation has been reported elsewhere in the world but not in the UK. If an increasing trend of long-stay admissions is evident, this may have significant implications for provision of paediatric intensive care in the future.Design/setting/patientsWe retrospectively analysed prospectively collected data from Birmingham Children’s Hospital, UK, over a 20-year period from 1998 to 2017. PICU admissions, bed-days, length of stay and mortality trends were analysed and reported over four different epochs (1998–2002, 2003–2007, 2008–2012 and 2013–2017) for long-stay admissions (PICU length of stay ≥28 days) and others. Differences in patient demographics, diagnostic categorisation and hospital utilisation were also analysed.ResultsIn total, 24 203 admissions accounted for 131 553 bed-days over the 20-year period. 705 (2.9%) long-stay admissions accounted for 42 312 (32%) bed-days. Proportion of long-stay admissions and corresponding bed-days increased from 1.6% and 20.5% in 1998–2002 to 4.5% and 42.6%, respectively, in 2013–2017 (p<0.001). Long-stay patients had a significantly higher number of hospital admissions (median: 4 vs 2, p<0.001) per patient and overall hospital length of stay (median: 98 vs 15, p<0.001) bed-days compared with other patients. Long-stay admissions were associated with significantly higher crude mortality (23% vs 6%, p<0.001) compared with other admissions.ConclusionsA significant increase in the proportion of prolonged PICU admissions with disproportionately high resource utilisation and mortality is evident over two decades.

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Section: Discussionmentioning

confidence: 99%

“…Demand for paediatric intensive care (PIC) is increasing in the UK 1. Insufficient paediatric intensive care unit (PICU) capacity results in cancelled operations and/or refused admissions 2.…”

Section: Introductionmentioning

confidence: 99%

Trends in long-stay admissions to a UK paediatric intensive care unit

et al. 2019

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“…The deterioration of lung function in disease as well as the need to treat acute exacerbations results in patients often requiring treatment in acute care settings and the delivery of aerosolized medications, such as antibiotics, bronchodilators, and inhaled corticosteroids. There are strong trends particularly in high-income countries towards increased admissions to and length of stay in ICU for pediatric [29,30] and especially geriatric patients with sepsis, respiratory disease, or nosocomial acquired conditions [31][32][33]. Diseases requiring inhalation therapies include asthma, bronchiectasis, COPD, CF, pneumonia, and ARDS [34][35][36].…”

Section: Development Of Nebulizersmentioning

confidence: 99%

Future Trends in Nebulized Therapies for Pulmonary Disease

McCarthy

González

Higgins

2020

JPM

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Aerosol therapy is a key modality for drug delivery to the lungs of respiratory disease patients. Aerosol therapy improves therapeutic effects by directly targeting diseased lung regions for rapid onset of action, requiring smaller doses than oral or intravenous delivery and minimizing systemic side effects. In order to optimize treatment of critically ill patients, the efficacy of aerosol therapy depends on lung morphology, breathing patterns, aerosol droplet characteristics, disease, mechanical ventilation, pharmacokinetics, and the pharmacodynamics of cell-drug interactions. While aerosol characteristics are influenced by drug formulations and device mechanisms, most other factors are reliant on individual patient variables. This has led to increased efforts towards more personalized therapeutic approaches to optimize pulmonary drug delivery and improve selection of effective drug types for individual patients. Vibrating mesh nebulizers (VMN) are the dominant device in clinical trials involving mechanical ventilation and emerging drugs. In this review, we consider the use of VMN during mechanical ventilation in intensive care units. We aim to link VMN fundamentals to applications in mechanically ventilated patients and look to the future use of VMN in emerging personalized therapeutic drugs.

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“…Staff need skills to manage both acute critical illness and palliative care at the end of life. Paediatric intensive care unit (PICU) admissions in the UK are rising above levels expected from the growing population 1. More and more patients have life-limiting conditions and multiple PICU admissions prior to death 2 3.…”

Section: Introductionmentioning

confidence: 99%

Psychological impact of working in paediatric intensive care. A UK-wide prevalence study

Jones¹,

Colville²,

Ramnarayan³

et al. 2019

Arch Dis Child

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ObjectiveTo determine the prevalence of work-related psychological distress in staff working in UK paediatric intensive care units (PICU).DesignOnline (Qualtrics) staff questionnaire, conducted April to May 2018.SettingStaff working in 29 PICUs and 10 PICU transport services were invited to participate.Participants1656 staff completed the survey: 1194 nurses, 270 physicians and 192 others. 234 (14%) respondents were male. Median age was 35 (IQR 28–44).Main outcome measuresThe Moral Distress Scale-Revised (MDS-R) was used to look at moral distress, the abbreviated Maslach Burnout Inventory to examine the depersonalisation and emotional exhaustion domains of burnout, and the Trauma Screening Questionnaire (TSQ) to assess risk of post-traumatic stress disorder (PTSD).Results435/1194 (36%) nurses, 48/270 (18%) physicians and 19/192 (10%) other staff scored above the study threshold for moral distress (≥90 on MDS-R) (χ2 test, p<0.00001). 594/1194 (50%) nurses, 99/270 (37%) physicians and 86/192 (45%) other staff had high burnout scores (χ2 test, p=0.0004). 366/1194 (31%) nurses, 42/270 (16%) physicians and 21/192 (11%) other staff scored at risk for PTSD (χ2 test, p<0.00001). Junior nurses were at highest risk of moral distress and PTSD, and junior doctors of burnout. Larger unit size was associated with higher MDS-R, burnout and TSQ scores.ConclusionsThese results suggest that UK PICU staff are experiencing work-related distress. Further studies are needed to understand causation and to develop strategies for prevention and treatment.

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Increasing admissions to paediatric intensive care units in England and Wales: more than just rising a birth rate

Cited by 25 publications

References 28 publications

Trends in long-stay admissions to a UK paediatric intensive care unit

Trends in long-stay admissions to a UK paediatric intensive care unit

Future Trends in Nebulized Therapies for Pulmonary Disease

Psychological impact of working in paediatric intensive care. A UK-wide prevalence study

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