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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1750298
Original Article

A Decade of Pediatric Intensive Care Outreach and the Deteriorating Child—The Relationship between Dose and Outcomes in a Tertiary Children's Hospital

Lynette Kirby 
1   Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
,
Jayshan Chagan
2   School of Medicine, University of Notre Dame, Sydney, NSW, Australia
,
Catherine Adams
1   Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
,
Natalie Duns
1   Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
,
Michael Haddad
1   Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
,
Sarah Pearson
1   Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
,
Oliver Tegg
1   Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
,
Chong Tien Goh 
1   Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, NSW, Australia
3   Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
› Author Affiliations Funding None.
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Abstract

The aim of this study is to evaluate the amalgamation and maturation of a Pediatric Intensive Care Outreach Service (PICOS) with a rapid response system (RRS) and associated outcomes over a 10-year period. It is a single-center retrospective study analyzing patient outcomes within the context of significant organizational changes introducing a track and trigger RRS called Between the Flags (BTF) and evolution of this system to electronic observation charting and alerts (eBTF) in a tertiary metropolitan children's hospital. Children on inpatient wards who required urgent activation of the RRS and admission to the pediatric intensive care unit (PICU) between 2009 and 2018 were included. Three cohorts were identified according to the system changes—pre-BTF (2009–2011), BTF (2012–2017), and eBTF (2017–2018). The PICOS dose (number of activations per 1000 hospital admissions) increased with the introduction of BTF and the RRS and this trend continued following eBTF. The number of PICU admissions via the PICOS did not vary across the decade. When comparing the pre-BTF to the BTF group, PICU mortality decreased (p < 0.05), Pediatric Index of Mortality 2 Risk of Death scores improved, and hospital length of stay decreased (p < 0.05) in the BTF group. Introduction of a track and trigger RRS and electronic charting augmenting an existing PICOS is associated with increasing dose and workload, with no significant impact on PICU admission rates or length of stay. PICOS patient mortality has notably decreased with the introduction of an RRS; however, this impact was not sustained with the addition of electronic charting and alerts in the patient medical record.

Keywords

rapid response - pediatric intensive care outreach - intensive care outreach - between the flags - medical emergency teams

Note

This study was conducted at The Children's Hospital at Westmead, Cnr Hawkesbury Rd & Hainsworth St, Westmead, NSW, Australia.




Publication History

Received: 22 February 2022

Accepted: 28 April 2022

Article published online:
11 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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