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

episodes continued for more than 72 hours, and only 6% extended beyond 7 days. Very few
children had episodes of care over 4 days out with the Children’s Hospitals.
The demographic breakdown of the audit cohort showed that the largest individual age group were
children under 1 year of age (1170, 24%); demonstrating demand for high dependency care was
greatest for the youngest children.
Data is presented in line with the definitions within the Emergency Care Framework (ECF) (2006):
Urban Level 2 Hospitals – District General Hospitals with no in-patient paediatrics, within
urban cities;
Rural Level 2 Hospitals – District General Hospitals with no in-patient paediatrics, within
remote and rural communities;
Level 3 Hospitals – District General Hospitals with in-patient paediatric units;
Children’s Hospitals (Level 4 Hospitals) - Royal Aberdeen Children’s Hospital; Royal
Hospitals for Sick Children in Edinburgh and Glasgow (Yorkhill, RHSC) and Tayside
Children’s Hospital (Ninewells).
(Note: Tayside Children’s Hospital (Ninewells) is an ECF Level 3 Hospital, but for the purposes of the audit it is
included as a Children’s Hospital in this Report)
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In most NHS Boards this will be located within the geographical boundary, but if not, the Board
should agree care and transfer/ transport arrangements for children and young people if first
admitted to a local Level 2 Hospital.
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Most children and young people require only a single short episode of HDC, it is therefore
inappropriate to transport children to a specialist Children’s Hospital, unless clinically essential. An
example of devolved high dependency care would be to develop the capacity to deliver short term
non-invasive ventilation (CPAP) in Level 3 Hospitals. This model of care has been implemented
successfully in the English South West Region Critical Care Network.
It is important that the quality of care delivered within local facilities remains high, enabling HDC to
be provided as close to home as possible. This has the additional benefit of protecting beds in the
Children’s Hospitals for specialist procedures and children who require higher levels of high
dependency care. A key aspect to ensuring the quality of service delivery will be the development
of a regional critical care network, to coordinate and plan the delivery of inpatient paediatric care,
anaesthesia / intensive care, surgical services, diagnostics and imaging along with high
dependency care.
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Guidance should be published to inform parents and ensure that a consistent message is
communicated by the Scottish Ambulance Service, GPs, Out of Hours Treatment Centres, NHS 24
and Minor Injury Units. Communication could be assisted through the use of the Child Health
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