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Exploring paediatric dietetic resources available for critically ill children in the UK and Ireland: A multicentre
Shalina Meah1, Catherine Kidd2, Brittany Rothman2
1Imperial College London NHS Trust, London, UK.
Insights
Paediatric intensive care units (PICUs) lack sufficient dietitian staffing, falling short of recommended ratios. Senior dietitian roles in PICUs also lag behind adult services, potentially impacting nutrition support.
Area of Science:
- Clinical Nutrition
- Pediatric Critical Care
- Healthcare Staffing
Background:
- A dedicated dietitian in the intensive care unit (ICU) multidisciplinary team improves nutrition support delivery.
- The Paediatric Critical Care Society recommends a 1:10 dietitian to critical-care bed ratio, led by an Agenda for Change (AfC) Band 7.
Purpose of the Study:
- To assess dietitian staffing levels and seniority in UK pediatric intensive care units (PICUs).
- To compare PICU dietitian staffing with recommended guidelines and adult critical care services.
Main Methods:
- A cross-sectional study utilizing a 12-week electronic survey.
- Data collected from all 28 UK hospitals with PICU beds, identified via the Paediatric Intensive Care Audit Network database.
Main Results:
- Only 14% of PICUs met the recommended 1:10 dietitian to bed ratio, with an average ratio of 1:23.7.
- PICU dietitian staffing (0.7 FTE) and seniority (predominantly AfC Band 7 leads) significantly differed from adult services.
- Adult services had a higher proportion of AfC Band 8a leads (12.5%) compared to PICUs (7%).
Conclusions:
- Significant disparities exist in dietitian seniority between adult and pediatric critical care services.
- Well-resourced PICUs with dietitians reviewing patients proactively may lead to improved nutrition outcomes.
Background:
A dedicated intensive care dietitian, as part of the intensive care unit (ICU) multidisciplinary team, contributes to improved delivery of nutrition support. The Paediatric Critical Care Society recommends a minimum dietetic staffing to critical-care bed ratio of 1:10, led by an Agenda for Change (AfC) Band 7.
Methods:
A cross-sectional study was conducted using an electronic survey that was available for 12 weeks. The Paediatric Intensive Care Audit Network database was used to identify all hospitals with paediatric intensive care unit (PICU) beds (n = 28).
Results:
Only 14% (n = 4/28) of trusts met the recommended 1:10 dietitian to bed ratio. PICU dietetic whole time equivalent was 0.7 ± 0.4, with a staff to bed ratio of 1:23.7 ± 10.7, compared to adult staff to bed ratio of 1:24.7. Some 92.8% (n = 26/28) had a AfC Band 7 Lead and only 7% (n = 2/28) had an AfC Band 8a Lead compared to adult services where 12.5% (n = 15/122) had an AfC Band 8a (p < 0.05).
Conclusions:
There is a significant disparity between adult versus paediatric services with regard to seniority of dietitians. Dietitians in well-resourced centres were more likely to review patients without the need for a referral, which may improve nutrition outcomes.
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