PICANET retrievals and referrals dataset

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PICANET retrievals and referrals dataset

• Allan Wardhaugh
• PICU consultant
• University Hospital of Wales
• Cardiff

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Rationale

• Captures an important missing population
• Patients referred for PICU but refused a bed
• Captures critical part of the patient journey
• Referral stabilisation retrieval sequence
  occurs in a phase of the illness where good
  management may have the biggest effect on outcome
  

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Currently collected

• Refused admissions
• Nothing
• Retrieval details
• 3 data fields

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Future data to be collected

• Refused admissions and reason for refusal
• Referring unit and referring team information
• Organisational aspects of retrieval team
• Personnel
• Vehicle
• Timing of each step in the process
• Quality indicators (?)

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Whats the point?

• Identify differences
• Organisational
• Referring units
• Quality assessment

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Design
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Design

• Reflected data currently collected by most units
  and retrieval services, but no collated by
  PICANET
• First draft volunteered in July 2006
• Electronic consultation with National Paediatric
  Retrieval Group over 5 months
• Final draft agreed by NPRG December after PICS
  meeting

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Old definition

• Any episode of a patient being admitted into a
  bed in a participating unit

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New definitions

• Any patient episode where a referral is made for
  a PICU bed in whom it is agreed by the PICU that
  a bed is required
• Any inter-hospital transfer episode for a child
  requiring, (or thought to require critical care
  at time of referral)

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Identifiers

• Unique PICANET ID
• Each episode of referral
• Patient episode ID
• Each referral episode within a patients illness
  episode
• Admission identifier
• Each admission or transport episode

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Quality indicators

• Seniority and speciality of staff present at
  referring hospital
• Interventions carried out by retrieval team in
  first hour of face to face contact
• Primary intubation
• Primary central venous/ IO access
• Chest drain insertion
• Commencing inotropes
• Critical incidents in transit
• Organisational delays

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Worked example

• Gareth Jones 2/12 old bronchiolitis
• Intubated and ventilated in Gloucester RI
• Referred to Birmingham Childrens Hospital PICU
• No bed
• Referred Bristol PICU
• No bed, could retrieve
• Referred Cardiff PICU
• Accepted

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Forms completed

• Birmingham
• Patient admission refused no staffed bed
• Bristol
• Form 1 refused admission
• Form 2 patient transfer Gloucester Cardiff
• Cardiff
• Patient admitted

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Next

• Deteriorates and referred to GOS for ECMO
• GOS accept
• CATS retrieve
• Comes off ECMO, still ventilated
• Repatriated to Cardiff by GOS team
• Discharged from Cardiff

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Forms

• GOS
• Patient admission
• CATS
• Patient transfer
• GOS
• Patient transfer (GOS Cardiff)
• Cardiff
• Patient admission

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Report

• National report describing numbers and
  organisational information as a whole and for
  each trust
• National summary of critical incidents and other
  quality indicators but no breakdown for
  individual trusts
• Local report describing breakdown of information
  from each referring unit
• Critical incidents and other quality indicators

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National example
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Local example
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Whats next

• Form re-design
• Database integration
• Trial run in selected regions
• Invite units to participate
• 6 12 months

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www.cardiffpicu.com