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Centralization of paediatric intensive care: are critically ill children appropriately referred to a regional centre?
1Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
Insights
Local physicians accurately identify critically ill children needing transfer to a tertiary pediatric intensive care unit (PICU). This ensures efficient use of specialized resources and appropriate patient care.
Area of Science:
- Pediatric Intensive Care
- Healthcare Systems
- Inter-hospital Transfers
Background:
- Hospitals without intensive care facilities rely on regional tertiary centers for critically ill children.
- Assessing the appropriateness of emergency referrals is crucial for efficient resource allocation.
Purpose of the Study:
- To evaluate the appropriateness of emergency inter-hospital transfers to a tertiary pediatric intensive care unit (PICU).
- To assess the skills of local physicians in recognizing and referring critically ill pediatric patients.
Main Methods:
- Prospective, descriptive study of pediatric patients (<18 years) referred to a tertiary PICU.
- Appropriateness defined by Paediatric Risk of Mortality (PRISM II) score >1% or need for ICU-dependent therapy.
- Effectiveness measured by PRISM II derived observed-to-expected mortality ratio.
Main Results:
- 86.2% of emergency referrals and 94.4% of actual transfers were deemed appropriate.
- Only 38 out of 436 emergency referrals were deemed inappropriate after consultation.
- Standardized mortality rate among emergency referrals was 0.613.
Conclusions:
- Local physicians effectively identify and request appropriate transfers for critically ill children.
- A centralized pediatric intensive care system facilitates efficient utilization of regional resources.
- Physician assessment skills in recognizing critical illness and transfer needs are adequate.
Objectives:
To evaluate the appropriateness of emergency referrals for inter-hospital transfers by local physicians in hospitals without intensive care facilities to a regional tertiary paediatric intensive care unit (PICU).
Design:
A prospective, descriptive study in a tertiary PICU and hospitals without paediatric intensive care facilities in and around the London area, UK.
Patients:
All patients (< 18 years) referred for emergency admission to the PICU from district hospitals (n = 436) as well as those admitted through other modes of admission (n = 286) between 1 October 1998 and 30 June 1999 were prospectively studied. Admissions and transfers were deemed appropriate if the risk of mortality using the Paediatric Risk of Mortality (PRISM II) score was greater than 1%, and/or if the patient required a unique ICU-dependent therapy. Effectiveness was estimated using PRISM II derived observed-to-expected mortality ratio. Of the 436 emergency referrals 398 (91.3%) were retrieved and transported to the PICU. Of these, 38 referrals were thought to be inappropriate after telephone consultation and were not transferred. Of the emergency referrals 376 (94.4%) had a mortality risk greater than 1% or required an ICU-dependent therapy on admission day. Thus 86.2% (376/436) of the referrals and 94.4% (376/398) of transfers were considered appropriate. The PRISM II derived standardized mortality rate was 0.694 (95% CI 0.517-0.913) in the overall population and 0.613 (95% CI 0.434-0.843) amongst the emergency referrals.
Conclusion:
Physicians at local hospitals within a centralized system of delivering paediatric intensive care were able to maintain adequate assessment skills in recognition and requesting for appropriate transfers of the most ill and efficiently utilized resources available at the regional centre.
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