CRITICAL CARE UNITS IN CHILDREN’S HOSPITALS PROVIDING SAFE CARE – BUT STAFF SHORTAGES MEAN BEDS REMAIN CLOSED

Dr Martina Healy, Clinical Lead for the Irish Paediatric Critical Care Audit (IPCCA) today launches the Irish Paediatric Critical Care Audit National Report 2017-2019. Dr Healy highlighted the excellent care provided to sick children in the Paediatric Critical Care Units (PCCUs) in Children’s Health Ireland at Crumlin and Children’s Health Ireland at Temple Street, which is safe and comparable to international standards. However, areas for improvement are noted such as optimising bed capacity in PCCUs to ensure vital PCCU beds are open and available for Ireland’s sickest children.

The IPCCA was established by the National Office of Clinical Audit (NOCA) and reports on the care of patients in PCCUs in Ireland. This is the first report of the IPCCA and outlines activity and benchmarked outcomes of critical care provided to the sickest children in Ireland during 2017 – 2019. It presents data on 4,490 infants, children and adolescents who were cared for across the two PCCUs in Ireland over the 3 year period. The audit also captures data on paediatric patients admitted to adult Intensive Care Units (ICUs), using data from the Irish National ICU Audit.

Dr Martina Healy, Clinical Lead for Irish Paediatric Critical Care Audit commented “This report highlights the excellent care provided to sick children in Irish PCCU’s, which is safe and compares favourably with units across the UK, despite staff shortages and the continuing high occupancy levels”.

KEY FINDINGS
• Irish PCCU’s are very busy with the provision of 30,000 critical care bed days to critically ill children and occupancy rates consistently greater than 95%, often over 100%. The recommended occupancy levels are 85%.
• There are currently 32 PCCU beds available over two PCCU sites in Ireland, but only 27 were consistently open and staffed 24/7 over the 3-year period. Improvements in staff retention and recruitment are required to provide optimal bed capacity and should be prioritised (by CHI).
• More than half (52%) of children admitted were infants aged less than one year. Almost three-quarters (72%) were aged less than 5 years.
• Over 60% of children and infants admitted required ventilation and vasoactive support.
• Three hundred children were transported by the Irish Paediatric Retrieval Service (IPATS) over the 3 year period and the extension of this service to 24/7 365 days a year is vital to the paediatric population regionally. IPATS provides regional Units with the backup needed if a child becomes critically ill and requires urgent transfer out to a PCCU.
• Outcomes are benchmarked against 30 other Units in the UK and Northern Ireland and compare favourably, including hospital mortality rates (96% survival rate, which equates to a crude mortality of 4%) and rates of emergency readmissions within 48 hours (1.5%). This demonstrates the importance of audit and shows that despite the strains placed on them, Irish PCCUs are safe and provide high quality care.
• The inclusion of data from regional Paediatric High Dependency Unit (PHDU) at University Hospital Limerick (UHL), and on children in adult ICUs is welcomed. The unit in UHL cared for 126 children in 2019. This allows sick children to be cared for locally. This regional PHDU model should be extended regionally to both Galway and Cork University Hospitals.
• In 2019, 111 children were admitted to adult ICUs; these patients should be cared for in a regional paediatric HDU or transferred out to PCCU as per national standards.
• Our ECLS (Extra Corporeal Life Support) service provided for 52 children at CHI Crumlin, although nine required transfer abroad for continuation of this life saving procedure. Nationally 21 children were transferred abroad for ECLS. This service should be provided in CHI Crumlin and extended to all children requiring ECLS in ROI as a priority.
Professor Adrienne Foran, Clinical Director, Children’s Health Ireland at Temple Street welcomed the report, commenting “As Clinical Director in Temple Street and for critical care for Children’s Health Ireland (CHI), I am witness to the wonderful care provided to the sickest children on a daily basis. This is despite the continued need for additional resources, especially the need for a dedicated surgical neonatal intensive care unit (NICU) and the progressing of respiratory ECMO service. The report highlights this care across all CHI. We welcome this audit and first report and congratulate Dr Martina Healy, Clinical Lead for the Irish Paediatric Critical Care Audit and colleagues.”

Copies of the report will be available to download from www.noca.ie/publications.