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

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TABLE OF CONTENTS...................................................................................................................................................... II
TABLE OF FIGURES, CHARTS AND TABLES ...............................................................................................................IV
SCOTTISH GOVERNMENT RESPONSE TO AUDIT OF HIGH DEPENDENCY CARE FOR CHILDREN AND YOUNG
PEOPLE IN SCOTLAND ...................................................................................................................................................VI
1. EXECUTIVE SUMMARY........................................................................................................................................... 1
1.1 BACKGROUND..................................................................................................................................................... 1
1.2 SUMMARY OF CORE DATA ................................................................................................................................... 1
1.3 RECOMMENDATIONS FOR NHS BOARDS................................................................................................................ 2
1.4 RECOMMENDATIONS FOR REGIONAL PLANNING GROUPS (AND NHS BOARDS).......................................................... 3
1.5 RECOMMENDATIONS FOR THE SCOTTISH GOVERNMENT, NHS EDUCATION FOR SCOTLAND, NHS QUALITY
IMPROVEMENT SCOTLAND, SCOTTISH AMBULANCE SERVICE, NATIONAL SERVICES DIVISION, REGIONAL PLANNING GROUPS AND
NHS BOARDS................................................................................................................................................................... 4
2. INTRODUCTION AND CONTEXT ............................................................................................................................ 6
2.1 PAEDIATRIC HIGH DEPENDENCY CARE IN SCOTLAND................................................................................................ 6
2.2 PAEDIATRIC HIGH DEPENDENCY CARE IN ENGLAND AND WALES ............................................................................... 7
2.3 PAEDIATRIC INTENSIVE CARE IN THE UK ................................................................................................................ 7
2.4 ORGANISATION OF CRITICAL CARE ........................................................................................................................ 8
3. AIMS & OBJECTIVES .............................................................................................................................................. 9
3.1 AIMS.................................................................................................................................................................. 9
3.2 OBJECTIVES ....................................................................................................................................................... 9
4. METHODOLOGY .................................................................................................................................................... 10
4.1 INTRODUCTION ................................................................................................................................................. 10
4.2 PILOT AND AUDIT ROLL-OUT................................................................................................................................10
4.3 INCLUSION / EXCLUSION CRITERIA ....................................................................................................................... 11
4.4 DATA COLLECTION METHOD................................................................................................................................11
4.5 VALIDATION OF DATA ......................................................................................................................................... 11
4.6 ORGANISATION OF CRITICAL CARE ...................................................................................................................... 12
5. RESULTS................................................................................................................................................................ 13
5.1 SUMMARY OF RESULTS ...................................................................................................................................... 13
5.2 DEMAND FOR HIGH DEPENDENCY CARE............................................................................................................... 15
5.2.1 Demand for high dependency care – NHS Boards.......................................................................... 15
5.2.2 Demand for high dependency care – hospitals ................................................................................ 15
5.2.3 Activity over the calendar year............................................................................................................ 18
5.2.4 Demographics........................................................................................................................................ 22
5.2.5 Activity by calendar year and age-range ........................................................................................... 23
5.3 WHERE HIGH DEPENDENCY CARE WAS DELIVERED ................................................................................................ 24
5.4 PROVISION OF HIGH DEPENDENCY CARE ............................................................................................................. 27
5.4.1 Elective / emergency episodes ........................................................................................................... 27
5.4.2 Length of episode.................................................................................................................................. 28
5.4.3 Multiple episodes of high dependency care...................................................................................... 33
5.4.4 High dependency care criteria ............................................................................................................ 34
5.5 PATIENT PATHWAYS.......................................................................................................................................... 36
5.5.1 Location before high dependency care.............................................................................................. 36
5.5.2 Location after high dependency care................................................................................................. 39
5.5.3 Primary journeys ................................................................................................................................... 43
5.5.4 Secondary journeys .............................................................................................................................. 44
6. ORGANISATION OF CRITICAL CARE .................................................................................................................. 49
6.1 NHS BOARDS.................................................................................................................................................. 49
6.2 LEVEL 2 HOSPITALS ......................................................................................................................................... 50
6.3 LEVEL 3 HOSPITALS ......................................................................................................................................... 52
6.4 LEVEL 4 HOSPITALS ......................................................................................................................................... 55
7. DISCUSSION .......................................................................................................................................................... 58
7.1 DEMAND FOR HIGH DEPENDENCY CARE ............................................................................................................... 58
7.2 WHERE HIGH DEPENDENCY CARE WAS DELIVERED ................................................................................................ 59
7.3 PROVISION OF HIGH DEPENDENCY CARE .............................................................................................................. 59