• Intensive Care Units, Paediatric
• Epidemiology

With the centralisation of paediatric intensive care services in England in the late 1990s, the development of transport services to transfer critically ill children from their local hospital to a tertiary centre became essential. To begin with, many of these services were provided by teams within those same regional paediatric intensive care units (PICUs), but over time specialist paediatric critical care transport services developed. The study by Ramnarayan et al1 describes how the development of a national database collecting data over a 10-year period across the UK and Ireland has been able to track more recent changes in provision, such that all areas are now covered by specialist paediatric critical care transport teams, along with a doubling in the number of transports led by an advanced nurse practitioner. At the same time, as well as having separately staffed transport teams, the auditing of performance has led to improvements in the speed at which teams mobilise for a transfer, although the challenges of geography and the minimal use of air transport may have limited any improvement in teams reaching the bedside of a critically ill child within 3 hours. Modelling has suggested that it may not be possible to optimise the arrangements that have developed regionally,2 such that advances in this latter metric may prove challenging.

The national database has been able to demonstrate trends in clinical practice, such as the reduced use of advanced vascular access with no significant change in the number of transfers requiring vasoactive infusions. …