Audit of High Dependency Care for Children and Young People in ...

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the management of unplanned care is greater in the Level 2 and 3 Hospitals (91%); nearly all elective admissions occurred in the Children’s Hospitals. ^ää=oÉÖáçå~ä=mä~ååáåÖ=dêçìéë=ëÜçìäÇ=ïçêâ=íÜêçìÖÜ=íÜÉ=~ÖêÉÉÇ=êÉÖáçå~ä=åÉíïçêâë=íç=ÉåëìêÉ= íÜÉêÉ=~êÉ=éçäáÅáÉë=ÑçêW== ~ÅÅÉëëáåÖ=~ÇîáÅÉ=êÉÖ~êÇáåÖ=íÜÉ=çåÖçáåÖ=ÅäáåáÅ~ä=ã~å~ÖÉãÉåí=çÑ=ÅÜáäÇêÉå=~åÇ=óçìåÖ= éÉçéäÉ=êÉèìáêáåÖ=ea`=çê=mf`X== ~êê~åÖÉãÉåíë=Ñçê=íÜÉ=íê~åëÑÉê=çÑ=íÜÉ=ÅÜáäÇ=íç=~åçíÜÉê=Ñ~Åáäáíó=ïÜÉíÜÉê=íÜáë=áë=Ñêçã= iÉîÉä=NLO=íç=iÉîÉä=PX=çê=Ñêçã=iÉîÉä=OLP=íç=çåÉ=çÑ=íÜÉ=`ÜáäÇêÉåÛë=eçëéáí~äëI=ÇÉéÉåÇÉåí= çå=ÅäáåáÅ~ä=åÉÉÇK= Table 16 (p47) highlights the number of regional secondary journeys that are occurring between hospitals. NKR= oÉÅçããÉåÇ~íáçåë=Ñçê=íÜÉ=pÅçííáëÜ=dçîÉêåãÉåíI=kep= bÇìÅ~íáçå=Ñçê=pÅçíä~åÇI=kep=nì~äáíó=fãéêçîÉãÉåí=pÅçíä~åÇI= pÅçííáëÜ=^ãÄìä~åÅÉ=pÉêîáÅÉI=k~íáçå~ä=pÉêîáÅÉë=aáîáëáçåI=oÉÖáçå~ä= mä~ååáåÖ=dêçìéë=~åÇ=kep=_ç~êÇë= ^=é~åJpÅçíä~åÇ=åÉíïçêâ=ëÜçìäÇ=ÇÉîÉäçé=~=ãáåáãìã=ëÉí=çÑ=ëí~åÇ~êÇë=íç=ÅçîÉê=~ää=~ëéÉÅíë= çÑ=é~ÉÇá~íêáÅ=ÅêáíáÅ~ä=Å~êÉI=Ñêçã=ÉãÉêÖÉåÅó=éêÉëÉåí~íáçåI=íÜêçìÖÜ=~åó=çåÖçáåÖ=áåé~íáÉåí= ã~å~ÖÉãÉåíI=íç=ÇáëÅÜ~êÖÉ=Ñêçã=ÜáÖÜ=ÇÉéÉåÇÉåÅó=Å~êÉ=Eáå=ÅçåàìåÅíáçå=ïáíÜ=íÜÉ=b`cFK==== == The network should work to develop critical care standards and operate as a forum for best practice. The network will ensure that standards relating to organisation, communication, and transfer are developed across Scotland. ^=é~åJpÅçíä~åÇ=åÉíïçêâ=ëÜçìäÇ=ÄÉ=ÇÉîÉäçéÉÇ=íç=~ÖêÉÉ=~=ãÉÅÜ~åáëã=íç=éêçãçíÉ=íÜÉ=çåÖçáåÖ= ~ìÇáí=çÑ=ÜáÖÜ=ÇÉéÉåÇÉåÅó=Å~êÉ=~åÇ=çìíÅçãÉëK= At present there is no process to capture clinical outcomes for HDC. As part of the HDC audit, an evaluation of existing provision of paediatric critical care was conducted within each NHS Board; providing the foundation for the development of a comprehensive set of critical care standards and audit. These national standards and a robust audit process would allow planners and managers to determine the existing resource and identify gaps in the service. This review process would also guarantee agreed standards of care; this work could fall under the remit of NHS Quality Improvement Scotland. kep=bÇìÅ~íáçå=Ñçê=pÅçíä~åÇ=~åÇ=oÉÖáçå~ä=tçêâÑçêÅÉ=aáêÉÅíçêë=ëÜçìäÇ=ÅçåÇìÅí=~å=ìêÖÉåí= åÉÉÇë=~ëëÉëëãÉåí=~åÇ=ÇÉîÉäçé=~=ïçêâÑçêÅÉ=ëíê~íÉÖó=íç=ÇÉäáîÉê=ÇÉîçäîÉÇ=é~ÉÇá~íêáÅ=ÜáÖÜ= ÇÉéÉåÇÉåÅó=Å~êÉ=áå=iÉîÉä=P=eçëéáí~äë=~åÇ=ã~å~ÖÉ=íÜÉ=ìåëÅÜÉÇìäÉÇ=éêÉëÉåí~íáçå=çÑ=íÜÉ= ÅêáíáÅ~ääó=áää=ÅÜáäÇ=áå=iÉîÉä=O=eçëéáí~äëK==qÜáë=ëÜçìäÇ=áÇÉåíáÑóW= = íÜÉ=åìãÄÉê=çÑ=~åÇ=íóéÉ=çÑ=éçëíë=êÉèìáêÉÇX= ÉÇìÅ~íáçå=~åÇ=íê~áåáåÖ=êÉèìáêÉãÉåíëX= Åçëí=çÑ=Ä~ÅâÑáääX= Å~éáí~ä=áåîÉëíãÉåíK= = qÜáë=ïçêâÑçêÅÉ=ëíê~íÉÖó=ëÜçìäÇ=ÄÉ=ëìÄãáííÉÇ=~ë=é~êí=çÑ=íÜÉ=ÄáÇÇáåÖ=éêçÅÉëë=Ñçê=íÜÉ=óÉ~ê=P= ÇÉîÉäçéãÉåíë=çÑ=íÜÉ=k~íáçå~ä=aÉäáîÉêó=mä~åK====== Q
NHS Boards and Regional Planning Groups should consider the development of practice exchanges to maintain the skills of staff working in Level 2 and 3 Hospitals. This is of particular relevance to remote and rural communities; it highlights that the reciprocal rotation of a highly skilled nurse from a Level 3 or Children’s Hospital to a Rural Hospital may be as appropriate and effective than rotating a remote worker into a large hospital for an update. The ‘skills bus’ model, which is currently being delivered by the PICU Retrieval team could also be extended maintain HDC skills. qÜÉ=pÅçííáëÜ=dçîÉêåãÉåí=ëÜçìäÇ=ÉåëìêÉ=é~åJpÅçíä~åÇ=éä~ååáåÖ=íç=ëìééçêí=ÉÑÑáÅáÉåí=~åÇ= ÉÑÑÉÅíáîÉ=áåíÉêJÜçëéáí~ä=íê~åëéçêí=Ñçê=áää=~åÇ=áåàìêÉÇ=ÅÜáäÇêÉåK= The audit recorded 910 secondary journeys, i.e. transfers between hospitals. At least 94% utilised ambulances (6% unknown); 40% were accompanied by paramedics and 53% by either a paediatric or neonatal specialist team, or medical and nursing staff. It is suggested that if transport arrangements were improved (i.e. enhanced training of paramedics and nurse practitioners), it would be possible to offer safe transfer within a regional network rather than relying on the Transport of Critically Ill and Injured Children Service (PICU Retrieval). This existing arrangement results in children being transferred (by default) to hospitals in Edinburgh and Glasgow, causing transport issues for their family & carers and in most cases a return journey following discharge. The audit data suggests that most HDC could be delivered in Level 3 Hospitals within a regional network structure; utilising PICU Retrieval when clinically necessary. The expectation is that the majority of these high dependency transfers could be delivered by nurse practitioners. = R
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Page 37 and 38: HDC Audit - Individual Length of Ep
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Page 41 and 42: Treatment code No. of children O 2
Page 43 and 44: Urban Level 2 - Admission From: HDU
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Level 3 Hospitals - High Dependency
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