High Dependency Care Audit for Children & Young People in Scotland – Interim Report

1. High Dependency Care Audit for Children & Young People in Scotland – Interim Report

2. Background to the High Dependency Care (HDC) Audit • The Kerr Report recommended: “that the age for admitting children & young people to acute care in paediatric facilities is up to their 16th birthday”. • Delivering for Health: • “continued provision of paediatric intensive care and high dependency care (HDC) is an immediate issue for NHSScotland in the light of trends in activity and case mix that may not be sustainable within current provision.” • SEHD commissioned NSD to conduct audit, to assess demand across Scotland and the current capacity to provide HDC: • quantity – high dependency care audit; • quality – assessing paediatric services against national standards (West Midland Guidelines).

3. HDC Audit - Methodology • Aim to identify where children with HDC needs are currently managed, how many, levels of HDC care and the number transferred. • Development of a set of national high dependency care criteria and classification standards. • 12-14 month prospective audit – in all hospitals across Scotland. • Include all children up to their 16th birthday. • Pilot conducted in wards within DGH, Tertiary Hospitals and Adult Hospitals.

4. HDC Audit – roll out began in October 2006, all hospitals were participating by end of Nov.

5. 12 hr episodes:day / night; changes in care

7. Airway / Circulatory Classifications

8. Co-ordination of HDC Audit • Each hospital has a designated co-ordinator and deputy. • Key to ensuring the quality of the data returned to NSD: • interpretation of HDC criteria – peer review; • link with NSD regarding queries on the audit forms; • meet regularly to discuss issues. • Completed forms returned on a weekly basis from paediatric wards and monthly basis from adult wards

9. Audit forms should contain – the patient’s complete journey Each form should contain the following: • hospital & ward; • patient details – CHI, DoB, Postcode, • type of admission – emergency / elective; • date & time per patient – when HDC commenced & ended, not shifts. • admission from – where was the patient prior to coming to the hospital; • primary journey – how did the child get to the hospital; • secondary journey – if child was transferred from another hospital – how was the child transferred; • end destination – when HDC ended where did the child go; • HDC criteria – for complete 12 hr period.

11. BRANNIGAN BRANNIGAN

13. HDC Audit progress • Database Issues: • delays developing database; • backlog of data entry; • quality of initial audit forms received – still working on clearing the outstanding queries; • delay in feedback to wards/hospitals. • Data presented is not complete due to backlog/queries. • Staffing issues within NSD. • To end of December information on 1369 children has been received. (Still adding to database for Jan/Feb - to date 1687)

14. Number of Children included in the HDC Audit * Significant amount of outstanding data entry

15. HDC Audit – planning tool / issues impacting on children’s services • Capacity: • no of HDC episodes; no. of children; episodes per child; • Location: • where do children receive HDC; type of hospital, regional location. • Demand: • proportion emergency / elective admissions. • Staffing: • proportion day / night HDC • Patient Pathway: • how many children are transferred to another hospital; • how do children arrive at hospital; • where do they go after HDC.

16. Breakdown of HDC for children in audit to date. HDC care provided in Short Stay, Paediatric Ward, HDU.

17. Breakdown of HDC for children in audit to date. HDC care provided in Short Stay, Paediatric Ward, HDU.

18. Patient Journey

19. HDC Audit – implications for children’s nurses • Aim is to produce report Spring 2008; supporting the planning of local, regional and national planning of critical care services. • Assessment of paediatric facilities, will be included in final report. • Provide evidence to support local needs analysis: • training – differing between hospital environments; • staffing levels; • facilities; • equipment • epidemiological data of patient base (Data Warehouse linkage).

20. HDC Audit – implications for children’s services • Ethos of Delivering for Health is to provide services as locally as possible. • Current paediatric service provision – centralisation of paediatric intensive care (2) and high dependency units (4). • This audit will identify the number of children with high dependency care needs across all hospitals and wards – linking to the development of a managed critical care network.

21. Acknowledgements to -Julie AdamsProject Manager National Services Division