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A national survey of current practice on patients with long term and additional needs in paediatric intensive care
Sofia Cuevas-Asturias1,2, Devika Arambepola2, Helen Cunningham2
1Paediatric Intensive Care Unit, Institute of Child Health, University College London, London, UK.
Insights
Patients with long-term and additional needs (LEAP) occupy 29% of UK paediatric intensive care unit (PICU) beds. Opportunities exist to improve care through streamlined pathways, designated funding, and enhanced collaboration for these complex pediatric patients.
Area of Science:
- Pediatric Critical Care Medicine
- Healthcare Management
- Patient Cohort Analysis
Background:
- Patients with long-term and additional needs (LEAP) represent a growing, heterogeneous group in pediatric intensive care units (PICUs), posing unique clinical challenges.
- Currently, no standardized approach exists for defining or managing this specific patient population within PICUs.
Purpose of the Study:
- To analyze bed occupancy rates for LEAP patients in UK PICUs.
- To examine current clinical practices for managing LEAP patients.
- To identify potential improvements in PICU care for this cohort.
Main Methods:
- A definition for LEAP patients was established (e.g., >14-day length of stay, life-limiting condition, multiple failed extubations).
- An electronic survey was distributed to all UK PICUs to gather quantitative and qualitative data on occupancy, management, and improvements.
- Data were collected between February and March 2022, analyzed using descriptive statistics and thematic analysis.
Main Results:
- 70.1% of UK PICUs responded, with LEAP patients occupying 25% of beds.
- Only 29% of responding units had tailored management plans for LEAP patients, though most had designated professionals.
- Key areas for improvement identified include care pathways, transitional units, funding, collaborative roles, and discharge planning.
Conclusions:
- LEAP patients constitute a significant proportion of PICU bed occupancy in the UK.
- While tailored management plans are uncommon, many PICUs have dedicated professionals for this cohort.
- Significant opportunities exist to enhance PICU care for LEAP patients through systemic improvements.
Background:
Patients with long term and additional needs (LEAP) in paediatric intensive care units (PICUs) are a growing and heterogenous cohort that provide unique challenges to clinicians. Currently no standard approach to define and manage this cohort exists.
Aim:
To analyse bed occupancy, examine current practice, and explore ideas to improve PICU care of patients with long term and additional needs.
Study Design:
Patients with LEAP were defined as meeting two or more of the following criteria: length of stay >14 days; life limiting condition; ≥2 failed extubations; hospital stay >1 month prior to PICU admission; likely to require long-term ventilation. An electronic survey was then sent to all UK PICUs, via the UK Paediatric Critical Care Society, to collect quantitative and qualitative data relating to bed occupancy, length of stay, multidisciplinary and family involvement, and areas of possible improvement. Data collection were occurred between 8 February 2022 and 14 March 2022. Quantitative data were analysed using Microsoft Excel 365 and SPSS Statistics version 28.0. Raw data and descriptive statistics were reported, including percentages and median with interquartile range for non-parametric data. Qualitative raw data were examined using thematic analysis. Analysis was undertaken independently by two authors and results assessed for concordance.
Results:
70.1% (17/24) PICUs responded. 25% (67/259) of PICU beds were occupied by patients with long term and additional needs. 29% (5/17) of responding units have tailored management plans to this cohort of patient. A further 11% (2/17) have guidelines for children with generic chronic illness. 12% (2/16) of responding units had a designated area and 81% (13/16) of responding units had designated professionals. The majority (68% and 62%) of responding units engaged families and community professionals in multidisciplinary meetings. When asked how the care of long term and additional needs patients might be improved five themes were identified: consistent, streamlined care pathways; designated transitional care units; designated funding and hospital-to-home commissioning; development of roles to facilitate collaboration between hospital and community teams; proactive discharge planning and parallel planning.
Conclusions:
This survey provides a snapshot of UK practice for a cohort of patients that occupies a considerable proportion (29%) of PICU beds. While only a minority of responding PICUs offer specifically tailored management plans, the majority of units have designated professionals.
Relevance To Clinical Practice:
Opportunities exist to improve PICU care in LEAP patients in areas such as: streamlined care pathways, designated clinical areas, designated funding, and development of defined collaborative roles. Next steps may involve working group convention to develop a consensus definition and share good practice examples.
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