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

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As part of the audit, an assessment tool was developed to map services available, within each
NHS Board, for the provision of high dependency care. The mapping tool was developed around
the format of the West Midland Guidelines (Standards for the care of critically ill and critically
injured children in the West Midlands, 2002) and incorporated the key elements of the Scottish
Emergency Care Framework (ECF) (2006).
The Emergency Care Framework provides a template for optimal paediatric emergency care,
based on a four level model of care:
iÉîÉä=NW The first contact for an acutely ill/injured child or young person with health services
is often their primary care provider (general practice), an out-of-hours service, ambulance
paramedics and increasingly, through telephone contact with NHS 24.
iÉîÉä=OW General hospitals with an Accident and Emergency Department but without a
Paediatric Inpatient Unit may have facilities for assessing and observing children and young people
over a period of time prior to making a decision about whether to discharge or not. However these
facilities are often open for a limited number of hours during the day and children and young people
who require admission need to be transferred to the local Inpatient Unit.
iÉîÉä=PW Emergency care should be available from a general hospital with a paediatric inpatient
unit which will have significantly more capacity to manage the unwell child or young person
than a hospital without such facilities.
iÉîÉä=QW Can be provided by specialist Children’s Hospitals or units, which provide paediatric
intensive care and/or advanced high dependency care, paediatric surgery and a range of specialist
services and advice, all of which are available on site.
The variation in NHS Board population requires different solutions to provide high dependency and
emergency care. The mapping tool was developed to reflect the services expected within ECF
Level 2, Level 3 and Level 4 Hospitals; an additional set of questions about the organisation of
critical care was developed for NHS Boards.
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