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

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A steering group was set up to oversee the progress of the project and advise on clinical,
managerial and regional issues. This group consisted of lead clinicians, senior nurses, service
managers, regional planners, representatives from NSD and the Scottish Government Health
Directorates (full membership can be found in Appendix 1, p71).
Existing data sources were unable to provide information about the demand for high dependency
care for children and young people in Scotland. This prospective audit was designed to capture
baseline information about this area of care.
Definitions of paediatric high dependency care vary across the UK. In recognition that children
present to a range of hospitals in Scotland for HDC, the Steering Group refined 50 criteria, to
define ‘high dependency care’ within this audit. The finalised criteria and guidance notes are in
Appendix 2 (p72).
Representatives from participating hospitals were invited to be members of the User Group. The
User Group provided feedback on the audit methodology and the members operated as local coordinators,
promoting the audit and monitoring the quality of audit returns.
A data collection system and reporting tool was developed to record all elements of the dataset on
a centralised database. The two-sided audit form was designed to capture information on aspects
of the child’s clinical pathway and HDC episode (a copy of the final format is in Appendix 3, p73).
An adapted version was completed by remote and rural hospitals, to include A&E Departments.
The form captured the following dataset items: patient, hospital and ward, admission type,
admission from, end of care destination, episode start and end dates and times, HDC criteria and
primary and secondary journey details.
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To ensure quantifiable and interpretable results, the methodology was piloted in a specialised
paediatric ward, a general paediatric ward and an adult ward. Modifications were made to the form
and process, following the results of the pilot exercise.
The roll-out of the audit commenced in October 2006, all hospitals were participating by early
November. Data was collected over a 14 month period, from October 2006 to the end of
November 2007. The aim of the audit was to present a summary of high dependency care activity
for a 12 month period; capturing the seasonal variation in activity.
Site visits were conducted, ensuring local staff and co-ordinators were aware of the objectives and
remit of the audit. Documentation was distributed to participating wards and posters were
displayed ensuring parents were aware of the audit (complying with Data Protection legislation).
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