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Impact of early warning on paediatric intensive care
  1. U Theilen1,
  2. P Leonard2,
  3. D Agrawal1,
  4. J Weitz1,
  5. D Simpson1
  1. 1Paediatric Critical Care, RHSC Edinburgh, Edinburgh, UK
  2. 2Paediatric Emergency Medicine, RHSC Edinburgh, Edinburgh, UK

Abstract

Aims To evaluate the impact of an early warning system and paediatric emergency team training on unplanned admissions to paediatric intensive care unit (PICU).

Methods An early warning system, which asks staff to respond to breaches of physiological criteria, was introduced to a paediatric teaching hospital. This was accompanied by a change in role of the resuscitation team to an “early response team”, reinforced by weekly 2-hourly simulation team training. The multidisciplinary training focuses on identifying deteriorating patients, communication within the team, and early escalation to consultant staff. A prospective audit covering the year before and after this intervention was conducted.

Results The number of unplanned admissions to PICU increased from 90 to 115, reflecting a similar increase of activity within the hospital. The year before introduction, the resuscitation team was called 11 times, in contrast to 36 involvements of the early response team the year after. The average time from breach of early warning criteria to first response (defined as: nursing intervention including increased observations, medical review, transfer to higher dependency unit) was reduced from 4.6 to 1.1 h. The proportion of deteriorating patients seen by a consultant, from the time of breach to PICU admission, increased from 49% to 82%. The time from breach to PICU admission fell from 21 to 10 h. Level of sickness at the time of admission to PICU was reduced by 24% (PIM1)/13% (PIM2). Length of PICU stay fell from an average 6.9 to 5.0 days, with the absolute number of bed days reducing by 10%. The number of deaths fell from 12 to 4.

Conclusion The authors observed major changes in the management of deteriorating paediatric inpatients: the response within the hospital was faster, involved more senior staff and lead to earlier PICU admission. This also applied when the paediatric emergency team was not called. Subsequently, predicted and actual PICU mortality and length of stay was reduced. This suggests that weekly team training, a local innovation to support early warning implementation, influences the judgement of key decision makers in the care of deteriorating patients both within the team and as individuals.

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