The Paediatric Intensive Care Audit Network (PICANet) collects data from Paediatric Intensive Care units (PICUs) across the country to compare their performance. One way it accumulates data is through the Paediatric Index of Mortality (PIM), which is a risk adjustment tool that uses primarily physiological data from the first hour of a patient’s admission on PICU to predict the risk of mortality for that patient. PICANet then uses the Standard Mortality Ratioto compare PICUs across the country. (1)
In 2015 there were 56 deaths in the Royal Manchester Children’s Hospital PICU. PIM2- the version on PIM used in 2015- predicted 26 deaths which meant there were 30 deaths that were unpredicted in 2015 meaning that RMCH had an SMR of 2.23 (95% Cl- 1.7–2.23), this suggests an excess mortality.
Method This report set out to evaluate PIM2 as to whether it is still fit for purpose as an indicator of quality of care in PICUs. This will be done by collecting data from all 56 patients that died on RMCH PICU in 2015 and review any incidents during their time on the unit that could contribute to their death. All PIM2 scores will be recorded for each patient meaning that the deaths that had a predicted mortality of <7.3% and therefore unpredicted can be reviewed in more detail. Finally the report will discuss why PIM2 failed to predict these deaths.
Conclusion Through reviewing all the 56 patients who died in RMCH PICU in 2015 it is clear that the raised SMR is due to PIM2 failing to predict deaths that were unavoidable. There was a rise in patients admitted with fatal, life limiting or severe diseases prior to admission. These diseases are not currently recognised by PIM2 so the calculated risk of mortality for these patients will be greatly decreased as there is no way of inputting these diseases so they get an appropriately weighted score. Other ways of assessing quality of care could be used by PICANet to get more reliable results. Alternately PIM2 should be updated further to incorporate rare but fatal conditions.
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