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Modelling the allocation of paediatric intensive care retrieval teams in England and Wales
Madeline King1,2, Padmanabhan Ramnarayan3, Sarah E Seaton4
1Washington University, St Louis, Missouri, USA.
Insights
Optimizing the location of paediatric intensive care retrieval teams (PICRTs) ensures 98% of critically ill children in England and Wales are reached within 3 hours. Reconfiguring PICRT services can improve coverage and response times for vulnerable patients.
Area of Science:
- Healthcare logistics
- Paediatric critical care services
- Spatial analysis in healthcare
Background:
- Specialist paediatric intensive care retrieval teams (PICRTs) were established in the UK in 1997 to transfer critically ill children from district general hospitals (DGHs).
- Current PICRT locations and catchment areas are based on historical referral patterns.
- National standards require PICRTs to reach patients within 3 hours of accepting a referral.
Purpose of the Study:
- To assess the proportion of demand for PICRT services in England and Wales reachable within 3 hours.
- To evaluate the impact of stricter 'time to bedside' standards on service coverage.
- To identify optimal PICRT locations for improved patient access.
Main Methods:
- Utilized mathematical location-allocation methods to optimize DGH to PICRT assignments.
- Minimized road journey times to determine optimal PICRT placements.
- Calculated demand coverage for various time thresholds (3 hours, 2 hours, 90 min, 75 min, 1 hour).
- Assessed the effect of altering the number and location of PICRTs on demand coverage.
Main Results:
- With 11 current/optimal PICRT locations, 98% of demand is reachable within 3 hours (98% optimal).
- Optimal locations improve reach within 2 hours (91% vs 86%), 90 minutes (69% vs 59%), and 75 minutes (39% vs 33%).
- Five hospitals were not reachable within the 3-hour standard.
- Eight optimally located PICRTs achieved similar 3-hour coverage as the current 11 locations.
Conclusions:
- Reducing the 'time to bedside' standard would leave more hospitals inadequately covered.
- Location-allocation optimization is a valuable tool for evidence-based reconfiguration of critical care services.
- Strategic placement of PICRTs is crucial for ensuring timely access to specialized paediatric care.
Background:
Following centralisation of UK paediatric intensive care units in 1997, specialist paediatric intensive care retrieval teams (PICRTs) were established to transport critically ill children from district general hospitals (DGHs). The current location and catchment area of PICRTs covering England and Wales are based on historical referral patterns. National quality standards specify that PICRTs should reach the patient bedside within 3 hours of accepting a referral.
Objective:
To determine what proportion of demand for PICRT services in England and Wales can be reached within 3 hours and to explore the potential coverage impact of more stringent 'time to bedside' standards.
Methods:
We used mathematical location-allocation methods to: (1) determine the optimal allocation of DGHs to current PICRT locations to minimise road journey time and calculated the proportion of demand reachable within 3 hours, 2 hours, 90 min, 75 min and 1 hour and (2) explore the impact of changing the number and location of PICRTs on demand coverage for the different time thresholds.
Results:
For current (and optimal) location of 11 PICRTs, 98% (98%) of demand is reachable within 3 hours; 86% (91%) within 2 hours; 59% (69%) within 90 min; 33% (39%) within 75 min; and 20% (20%) within 1 hour. Five hospitals were not reachable within 3 hours. For the 3-hour standard, eight optimally located PICRT locations had similar coverage as the current 11 locations.
Conclusions:
If new evidence supports reduction in the time to bedside standard, many more hospitals will not be adequately covered. Location-allocation optimisation is a powerful technique for supporting evidence-based service configuration.
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