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We commend the DEPICT group for gathering evidence to support or refute the current set of performance standards for specialist paediatric intensive care retrieval teams (PICRTs), for which there is currently limited evidence base.
A key tenet of ‘the paper’ was geographical distance as the sole reason for a breach in the 180 minute to bedside standard. In our experience, the commonest reason to breach was ‘team availability’. In 2018 South Thames Retrieval Service (STRS) performed 824 emergency retrievals. In 4% of these, the team did not reach the bedside within 180 minutes. On 33/36 occasions, the reason for delay was lack of availability of retrieval team due to concurrent deployment.
STRS is commissioned to staff two teams on every shift. In 2018 32% of retrievals were performed concurrently. STRS is the second busiest PICRT in the UK, however on 29 % of shifts, no retrieval team was launched. STRS is a fully integrated retrieval service –all staff are based in the intensive care unit, and when not on retrieval work clinically in the PICU. This allows flexible staffing and in times of high demand, helps support increased PICU bed capacity. In 2018, 98.8% of patients were kept within region.
The authors highlight the importance of mobilisation time. Despite the integration of our service within a busy PICU, STRS recorded the highest national compliance with the mobilisation standard for 2017.
In our region 90% of intubations are p...
In our region 90% of intubations are performed by the referring team. The integrated PICU- PICRT model allows all staff to remain proficient in practical skills required for retrieval but infrequently performed during transfer.
An additional benefit of co-location of services is the reduction in re-deployment time when a patient returns to the base PICU. Co-location in the busiest receiving units would allow maximum benefit from this time saving and should be considered in future analyses.
We agree with the authors and acknowledge PICRT as an expensive resource. We suggest therefore that the most flexible, practical, financially viable team utilisation models need to be considered in any service redesign. As well as co-location with a PICU, we argue for greater integration of the teams within the PICUs themselves.
1. King M, Ramnarayan P, Seaton SE et al Modelling the allocation of paediatric intensive care retrieval teams in England and Wales. Archives of disease in Childhood Published online First: 11 February 2019.
2. Paediatric Intensive Care Audit Network Annual Report 2017 (published November 2017): Universities of Leeds and Leicester.