Differences in access to Emergency Paediatric Intensive Care and care during Transport (The DEPICT Study)

What is this research about?

There are fewer than 30 specialist intensive care units for children (called PICUs) in the UK. This means that a sick child taken to their nearest hospital will often need to be transferred to a PICU, which may be several miles away. Transports of sick children are usually done by mobile intensive care teams called PICU retrieval teams (PICRTs).

The way in which PICRTs are organised and deliver clinical care varies across the UK, especially in terms of factors such as how quickly PICRTs can reach a sick child at the local hospital and whether senior staff are present on the retrieval team. There has been little research into how these differences might influence the outcomes for sick children (and their families’) experiences. In short, we do not know if national variation in how PICRT services are organised and delivered matters, or whether current quality standards help achieve the best outcomes for patients.

As part of the DEPICT study, we aim to understand how existing differences in access to paediatric intensive care and care provided by PICRTs affect clinical outcomes and experiences for transported critically ill children and families. We will do this in four distinct, but inter-related, workstreams (quantitative analysis, qualitative and questionnaire study, health economic evaluation and mathematical modelling).

How is ICNARC involved in DEPICT?

ICNARC will be involved in the quantitative analysis part of the DEPICT study, which will be performed at the University of Leicester (led by Prof Elizabeth Draper). During the quantitative analysis a study dataset will be generated by linking data from several sources. The Case Mix Programme (CMP) will be one of four different sources of data used in the linkage.

ICNARC will send NHS Digital from the CMP database a list of children under 16 years old who were admitted to an adult general critical care unit in England and Wales between 2014 and 2016. Approval for patient identifiable data to be sent to NHS Digital for linkage will be obtained from the Health Research Confidentiality Advisory Group under Section 251 and from a Research Ethics Committee.

What will the DEPICT study data contain?

The DEPICT study dataset will consist of linked data from several sources:

  1. Paediatric Intensive Care Audit Network (PICANet)
  2. The CMP 
  3. Hospital Episode Statistics acute hospital admission data 
  4. Office of National Statistics mortality data

Data linkage for the study will be performed by NHS Digital after all relevant regulatory approvals have been granted.

The DEPICT study dataset itself will not contain any confidential or patient identifiable information, only a unique record identifier will be used (pseudonymised dataset). After data linkage, NHS Digital will send the study dataset to the University of Leicester where the analysis will be conducted. The study dataset will cover the entire patient pathway of a sick child, from care provided at the acute hospital, admission(s) to an adult critical care unit, if applicable, the transport of critically ill children to a PICU, their admission to PICU and long-term outcome including mortality.

The study dataset will be analysed to examine various aspects such as how long it takes a PICRT to reach the patient, how long it takes the child to reach the PICU, the seniority of clinicians performing the transport, medical procedures performed by the PICRT and any critical incidents during transport, and investigate whether any of these factors influence how likely a child is to survive in the first 30 days after admission to intensive care.

Who funds this research and who works on it?

This research is funded by the National Institute of Health Research (NIHR) – Health Services and Delivery Research (HS&DR) Programme (Project: 15/136/45). Tim Russell, Technical Services Manager at ICNARC, is part of the DEPICT research team.

 

 

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