Aim The Paediatric High Dependency Audit was commissioned by the regional network to identify paediatric high dependency (PHD) activity within a specific region that has 4 funded HDU beds.
Method Details of patients fulfilling the HDU criteria were collected on each site. The anonymised data was analysed centrally. Each site was visited by the lead nurse for quality purposes. Each patient fulfilling audit criteria was confirmed by the local investigator and final data checked by the lead nurse and lead clinician. PHD activity was recorded by type, diagnosis, location and length of stay (LoS) according to HRG criteria (Paediatric Minimal Care Dataset 2007) and additional criteria agreed relevant by the nine network Hospitals. A lead audit nurse was employed for audit development, analysis and data collection. A similar audit has been performed in the South West region of England.
Results The network covers a paediatric population of approximately 500 000 children with nine hospitals all referring to one Paediatric Intensive Care Unit. The network crosses the SHA boundaries. Over a 12 month period, 2500 HDU activities were recorded. Within the HRG criteria the commonest indication for HDU care was oxygen therapy with saturation recording (1100). Within this group 210 had this identified as a single HDU criteria. The remainder had other interventions noted. For example, intravenous or continuous nebulised salbutamol (708), high oxygen requirements exceeding 40% (707), prolonged or recurrent convulsions (110), DKA with electrolyte abnormalities (96) and meningococcal sepsis (57) were identified most frequently as HDU activity by diagnosis. We believe there was significant underreporting of isolated oxygen therapy. LoS per patient varied between units with the individual unit median times ranging between 21.5 and 45 h. Over 1600 episodes were managed on the general paediatric ward or HDU areas utilizing the ward based staff.
Conclusions HDU activity is common on general paediatric wards. It is underrecognised and better recording of activity is a prerequisite to improved funding. Training and organisational needs are apparent.