Aims The structure of paediatric critical care (PCC) in the UK is under review.1 This study aimed to evaluate the paediatric high dependency unit (PHDU) workload at our district general hospital, mapping it to the Paediatric Critical Care Minimum Dataset (PCCMDS).
Methods The demographics, diagnostic category, interventions required and outcomes of all PHDU admissions were recorded prospectively over a 4 month period (winter 2016–2017). Demographic data was compared to previous local PHDU audits and the intensity of interventions each patient received was assessed using the PCCMDS.
Results 105 patients were admitted with a mean age of 4.9 years (median 2.6 years, range 12 days–16 years 3 months). Age distribution was similar to previous years but number of admissions has greatly increased (n=34 in 2000–2001). Respiratory admissions are increasingly common (33% in 2000–2001 vs 55% in 2016–2007). Mean length of stay was 1.6 days (range 3 hours-12 days). 90 patients were discharged to the ward or home and 9 transferred to a tertiary centre (6 to paediatric intensive care, 1 to PHDU, 2 to wards). Outcome data was not recorded for 6. Regarding intensity of care: 66 patients received PCCMDS basic interventions; with 2 further patients meeting the suggested new criteria.1 11 patients had intermediate interventions (8 also had basic interventions). 34 patients received no PCCMDS interventions. These were mainly neurology (n=13) and poisoning (n=9) admissions. 3 of this sub-group received volume resuscitation and 4 were transferred to a tertiary centre.
Conclusions Paediatric high dependency workload is increasing, particularly respiratory admissions. The PCCMDS improves understanding of the PHDU workload and will enable comparison of work between units. However 32% of patients admitted to our PHDU received no PCCMDS interventions prompting review of our PHDU admission criteria and highlighting that some interventions are not recognised by the PCCMDS (including volume resuscitation and observation after prolonged seizures) leading to potential underestimation of workload. We recommend further modification of the PCCMDS to account for this.
. High Dependency Care for Children – Time To Move On, RCPCH, 2014.
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