G211 Designing a critical care outreach service – an audit and national survey

Critical Care outreach services for adults have been shown to reduce mortality. It has also been demonstrated consistently that review of step-down patients on the ward reduces readmission to ICU and is therefore cost effective. There is, however, no published evidence on the benefit or lack thereof of critical care outreach services for children. The Bedside PEWS score has been found to predict critical deterioration with a median score of 8 in deteriorating patients on paediatric wards. A review of recent serious incident investigations within our NHS Trust identified a common theme of ‘failure to escalate care in the deteriorating patient.’ Aims With a view to designing a critical care outreach programme, we completed a national survey of all British paediatric intensive care units to discover what percentage of units have a funded service, and whether this is staffed by nurses or doctors. We then carried out a review of the last 1 year of ‘internal collapse’ admissions from the paediatric wards to PICU within 1 NHS Trust to assess the time of day that critical care admissions most commonly occurred, and to confirm that a BPEWS of 8 would predict deterioration in our population. Method A telephone survey of all PICUs listed in the PICANET database. A case note review of the previous 1 year of admissions to PICU from wards within the same hospital. Recorded was time of admission, BPEWS score at admission, and maximum BPEWS in the 12 hours prior to admission. Results Of the 27 PICUs listed in the database, 9 have funding for a critical care outreach service. In all apart from 1 this was a nurse led service. The mean and median PEWS scores for the internal collapse patients were 8 at the time of admission, and a mean maximum of 9 during the previous 12 hours. 39% of admissions to PICU from paediatric wards occurred between 0800–1700 hrs, 45% between 1400–2200 hrs and 26% between 2200–0800 hrs. Conclusion A third of PICUs had a dedicated critical care outreach service. A day-time only service would miss 25% of admissions. A BPEWS of less than 8 should be used as a trigger for review.