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Changes in the profile of paediatric intensive care associated with centralisation
G Pearson1, P Barry, C Timmins
1Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK. Gale.pearson@bhamchildren.wmids.nhs.uk
Insights
Centralizing pediatric intensive care services led to more children receiving care and a significant decrease in child mortality. This suggests that unmet needs for pediatric intensive care may have existed previously.
Area of Science:
- Pediatric critical care medicine
- Public health policy
- Healthcare systems analysis
Background:
- Paediatric intensive care (PIC) services underwent significant organizational changes and centralisation between 1991 and 1999.
- Understanding the impact of these changes on access to and outcomes of PIC is crucial for healthcare planning.
Purpose of the Study:
- To compare paediatric intensive care admissions in 1991 and 1999 within a defined population.
- To evaluate the effect of centralisation and organizational changes on PIC utilization and child mortality.
Main Methods:
- Population-based audits were conducted over two 12-month periods (1991 and 1999).
- Data on intensive care admissions, mechanical ventilation use, mortality, and length of stay were collected for children (<15 years) in Birmingham.
- Admissions data were compared with Office for National Statistics denominator data.
Main Results:
- Paediatric intensive care admissions increased significantly, from 1.3 to 2.3 per 1,000 children annually.
- Centralisation led to a higher proportion of admissions to the main PIC unit (60% to 90%) following its expansion.
- Child mortality decreased by 34 deaths per 100,000 children, while the need for mechanical ventilation at admission remained constant.
Conclusions:
- The centralisation and expansion of the lead PIC centre were associated with increased PIC utilization, indicating a potential unmet need in 1991.
- Centralisation of paediatric intensive care services may have contributed to the observed reduction in child mortality.
Objectives:
To compare intensive care admissions from a defined population of children in 1991 and 1999, during a period of organisational change and centralisation of paediatric intensive care.
Design:
Two 12-month population-based audits were compared. Data were collected from hospitals in Birmingham and the surrounding districts. Denominator data were obtained from the Office for National Statistics. The place and rate of intensive care admission, the use of mechanical ventilation at admission, mortality and length of stay were compared.
Setting:
Hospitals in the West Midlands.
Participants:
All children (<15 yrs) living in Birmingham who received intensive care during the study periods.
Measurements And Results:
The number of Birmingham resident children admitted for intensive care increased from 277 to 510 (p<0.0001) i.e. from 1.3 to 2.3 admissions per 1,000 children per year. The proportion of admissions to the principal paediatric intensive care unit increased from 60% to 90% (p<0.0001) in association with its expansion from 6 to 18 beds. Length of ICU stay decreased from 103 to 74 h (difference 29 h, 95%CI, 4.78-54.2 h, p=0.0117). Child mortality fell over this period by 34 deaths per 100,000 children (95%CI 16-51, p<0.0001). The proportion of children requiring mechanical ventilation at admission to intensive care was unchanged.
Conclusions:
Centralisation by expansion of the lead centre was associated with a large increase in the numbers of children receiving intensive care consistent with an unmet need for paediatric intensive care in 1991, which may still exist. Centralisation of paediatric intensive care may have contributed to the fall in child mortality over this time period.