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Differences in access to Emergency Paediatric Intensive Care and care during Transport (DEPICT): study protocol for a
Padmanabhan Ramnarayan1, Ruth Evans2, Elizabeth S Draper3
1Children's Acute Transport Service, Great Ormond Street Hospital For Children NHS Trust, London, UK.
Insights
Variations in UK paediatric intensive care retrieval teams (PICRTs) impact patient outcomes and family experiences. This study investigates these differences to improve care for critically ill children during transport.
Area of Science:
- Paediatric intensive care medicine
- Healthcare service delivery
- Transport medicine
Background:
- Specialist paediatric intensive care retrieval teams (PICRTs) are crucial for stabilising and transporting critically ill children in the UK.
- Existing national variations in PICRT response times and care practices are not well understood.
- The impact of these service variations on clinical outcomes and stakeholder experiences remains largely unknown.
Purpose of the Study:
- To address the evidence gap regarding the impact of variations in paediatric intensive care retrieval team services.
- To assess how differences in PICRTs affect clinical outcomes, patient/family experiences, and cost-effectiveness.
- To generate recommendations for optimizing PICRT service configurations.
Main Methods:
- Mixed-methods approach combining retrospective data analysis (2014-2016) of clinical audits.
- Prospective data collection via questionnaires and in-depth interviews with patients, families, and staff (2018).
- Health economic evaluation and mathematical modelling of transport service costs and outcomes.
Main Results:
- Analysis of linked clinical audit data to evaluate the impact of service variations on 30-day mortality and other clinical outcomes.
- Collection of patient and family experience data through questionnaires and interviews across 24 PICUs and 9 PICRTs.
- Economic evaluation of transport costs versus lives saved and quality of life at 12 months.
Conclusions:
- The study aims to provide crucial evidence on the effectiveness and patient experience associated with different paediatric intensive care retrieval team models.
- Findings will inform the development of best practices and service configurations for PICRTs.
- Dissemination of results through multiple channels, including peer-reviewed publications and stakeholder workshops, will drive improvements in paediatric critical care transport.
Introduction:
Following centralisation of UK paediatric intensive care, specialist retrieval teams were established who travel to general hospitals to stabilise and transport sick children to regional paediatric intensive care units (PICUs). There is national variation among these PICU retrieval teams (PICRTs) in terms of how quickly they reach the patient's bedside and in the care provided during transport. The impact of these variations on clinical outcomes and the experience of stakeholders (patients, families and healthcare staff) is however unknown. The primary objective of this study is to address this evidence gap.
Methods And Analysis:
This mixed-methods project involves the following: (1) retrospective analysis of linked data from routine clinical audits (2014-2016) to assess the impact of service variations on 30-day mortality and other secondary clinical outcomes; (2) a prospective questionnaire study conducted at 24 PICUs and 9 associated PICRTs in England and Wales over a 12-month period in 2018 to collect experience data from parents of transported children as well as qualitative analysis of in-depth interviews with a purposive sample of patients, parents and staff to assess the impact of service variations on patient/family experience; (3) health economic evaluation analysing transport service costs (and other associated costs) against lives saved and longer term measurements of quality of life at 12 months in transported children and (4) mathematical modelling evaluating the costs and potential impact of different service configurations. A final work stream involves a series of stakeholder workshops to synthesise study findings and generate recommendations.
Ethics And Dissemination:
The study has been reviewed and approved by the Health Research Authority, ref: 2 18 569. Study results will be actively disseminated through peer-reviewed journals, conference presentations, social media, print and broadcast media, the internet and stakeholder workshops.
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