The report, commissioned by the Healthcare Quality Improvement Partnership and carried out by the Paediatric Intensive Care Audit Network (PICANet) showed that death rates in children’s intensive care units are low and continue to fall.
However this national audit found that around two-thirds of children’s intensive care units across Britain and Ireland were running without the recommended number of qualified nurses. Just 13 of the 34 units surveyed met the new standards for nursing staff as recommended by the Paediatric Intensive Care Society.
Professor Elizabeth Draper, co-principal investigator of PICANet from the University of Leicester, commented: “Qualified nurse staffing levels have improved over time, with more than three quarters of Paediatric Intensive Care Units meeting the old standard. But following the revision of these standards in line with the recommendations of the Royal College of Nursing, fewer than 40% of units now achieve the required levels of qualified nursing staff.”
PICANet collected data from 30 institutions providing paediatric intensive care. They at looked at details of 52,000 admissions to these units of nearly 39,000 individual children aged between 0 and 15 years over a three year period from 2008 to 2010. This included where each child was admitted, their diagnosis and the treatment they received, how long they remained in intensive care and the eventual outcome.
The report showed that overall, the death rate in paediatric intensive care units is continuing to fall, dropping from 4.5% in 2008 to 3.8% in 2010. However, a separate analysis of data from units in England and Wales showed that the mortality rate for children with asthma who required help with their breathing was relatively high compared to other developed countries.
“It is extremely rare for children to die in paediatric intensive care and the majority leave this type of specialist care alive,” said Dr Roger Parslow, a senior lecturer at the University of Leeds and co-principal investigator of PICANet. “However, as our work on asthma shows, it is still important for clinical audits, like PICANet, to work with doctors and nurses by monitoring performance and clinical outcomes to help them provide the best quality of care to children in paediatric intensive care units.”
“It is concerning that the death rate in England and Wales for asthma admissions to paediatric intensive care units is relatively high compared to other developed countries. The PICANet data has been very useful in highlighting this issue but it cannot identify why this is the case and what can be done about it,” said Dr Andrew Durward, from Evelina Children’s Hospital in London, who co-led the analysis of asthma data.
A snap-shot survey of staffing levels across the institutions also highlighted the mismatch between standards set by the Paediatric Intensive Care Society and the situation on the ground. Only 38% of institutions met the recommended ratio of nursing staff to children’s intensive care beds.
The eighth annual report from PICANet on activity and outcome in paediatric intensive care services throughout the UK and Ireland is available to download free from here: www.picanet.org.uk.
A National Review of Asthma Deaths has been commissioned by the Health Quality Improvement Partnership (HQIP).
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Notes to Editors:
1. PICANet has been collecting data on all admissions to paediatric intensive care in England and Wales from 2002 and has expanded to include Scotland, Northern Ireland and Southern Ireland. It currently holds data on over 120,000 admissions. The information held on the PICANet database has been used by the Department of Health, strategic health authorities, commissioners, clinical audit teams, researchers and individual institutions to improve the delivery of paediatric intensive care.
2. PICANet is funded by the National Clinical Audit and Patient Outcomes Programme via the Healthcare Quality Improvement Partnership (HQIP), Health Commission Wales Specialised Services, NHS Lothian / National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children, Our Lady’s Children’s Hospital, Crumlin, Children’s University Hospital, Temple Street and The Harley Street Clinic, London.
3. HQIP: The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact of clinical audit in England and Wales. HQIP hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The programme comprises 29 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions, including PICANet.
4. Asthma is one of the commonest respiratory diseases in childhood. Despite advancement in diagnosis and treatment, it continues to impose a major burden on health care services. Although an asthma attack can require admission to hospital, it is unusual for a child with asthma to require admission to intensive care.
5. Dr Andrew Durward and Dr Andrew Nyman from Evelina Children’s Hospital in London, analysed data for England and Wales from PICANet and showed that the number of children admitted to intensive care for asthma increased by 67% from 2005 to 2010 with 1640 admissions of children between 1 and 16 years of age in this period. Forty percent of children admitted to paediatric intensive care needed mechanical help with their breathing. The death rate in these children was 4.7% compared to a rate below 2% in children admitted with asthma to paediatric intensive care in Australia and USA.
6. One of the UK’s largest medical, health and bioscience research bases, the University of Leeds delivers world leading research in medical engineering, cancer, cardiovascular studies, epidemiology, molecular genetics, musculoskeletal medicine, dentistry, psychology and applied health. Treatments and initiatives developed in Leeds are transforming the lives of people worldwide with conditions such as diabetes, HIV, tuberculosis and malaria. www.leeds.ac.uk
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Issued by University of Leeds, University of Leicester and Healthcare Quality Improvement Partnership (HQIP) on 10 October 2011