The Significance of a Paediatric Retrieval Service - Essay Example

?Paediatric Retrieval Team: Critical Care on Mobile Every year thousands of children are admitted due different types of sicknesses and diseases. This population of small people are deemed high risk for mortality and morbidity if not given proper attention. According to the data presented by the Paediatric Intensive Care Audit Network in its Annual Report, there are 52,337 paediatric intensive care admissions aged below 16 years of age to 29 National Health Services trusts and health authorities, over the three year period from January 2008 to December 2010 (Paediatric Intensive Care Audit Network, 2011). These numbers shows a significant number that still a lot of children are admitted every year due to critical conditions and services must be boosted to address these growing numbers and to lessen the likelihood of increase in child morbidity. In a primary health care setting some infants and children even progress to critical cases such as respiratory distress leading to failure, sepsis, neurological cases due to infection and trauma due to sudden accidents such as fall. All these cases need special paediatric attention and critical care. In such cases, especially in rural areas, the aim of parents of sick children is to rush these kids into the nearest primary hospital available to the area for immediate healthcare assessment and care. Once these children are seen in the primary hospital assessment is made and first aid treatments are given to address the immediate presenting problem. But the problem arises once assessment by a physician in the general hospital reveals more critical cases that need more advance and immediate medical care needing admission to a high level critical unit available in tertiary and specialty hospitals. Such cases of cardiac anomaly accompanied with respiratory failure where intubation is done to help aid a child breath by the use of an assistive breathing machine called a mechanical ventilator. Critical care and other advance treatments and diagnostic procedures are needed to pursue to save the life of critically ill child. Hospitals and health care facilities sometimes lack the equipment to attend to the critical needs of these children that immediate transfer to able hospitals or specialty hospitals are needed. In such given situations, paediatric retrieval of tertiary hospitals comes in significance. This paper will tackle paediatric retrieval in all its aspects and its impact and relevance to the field of critical care management. In the context of this paper will be the discussion on creation of a paediatric retrieval team and the certification and trainings needed to be able to comply as a member of the team as well as the comparison and studies citing the significance, edge, and comparison of transferring with a paediatric retrieval team other to other means of transport. What is paediatric retrieval? To fully understand the significance of a paediatric retrieval service is to go over the definition and concepts that consists the service. According to University Hospital Southampton (2011), the Paediatric Retrieval Service consists of a highly skilled team who have specialist training in the transfer of sick children from other hospitals to the Paediatric Intensive Care Unit. According to their definition, the team of a paediatric retrieval service is comprised of trained staff consisting of a doctor, nurse, technician and an ambulance driver. To have an efficient paediatric retrieval team is also to have a dedicated ambulance that is fully equipped with advance medical machines such as cardiac monitor, defibrillator, and mechanical ventilator and other medical materials and drugs needed to provide mobile intensive care facilities to these critically ill children and to attend to emergency situation due to such critical conditions that may occur during transfer (University Hospital Southampton, 2011; South Thames Retrieval Service, 2012). For the process of retrieval to take place, the referring medical team will contact the receiving hospital when they admit a seriously ill child. Taking for example the paediatric retrieval team service activation of University Hospital Southampton, referral calls from the referring medical team of a primary hospital will allow the hospital’s paediatric intensive care unit consultant to assess the patient’s condition in from the start of the referral process. By this the receiving hospital will have the full scope of what to expect and what medical approach can be given to the critically ill child so no time is wasted. Moreover, the receiving hospital will be able to prepare medical and diagnostic equipments they will need to better attend to the needs of the critical child for better management and at the same time the team of receiving doctors can advice the medical team of the referring hospital on what else needs to be done to stabilize the patient before transfer. During the process, the receiving medical team can provide advice and support to the local hospital team on the management of a child or if the child needs more specialist treatment will activate the retrieval team to transport the child to the receiving specialty hospital (University Hospital Southampton, 2011). The retrieval team members have extensive experience caring for critically ill and injured children and are able to care for children with life-threatening conditions, illnesses, or injuries (West Midlands Specialised Commissioning Group, 2009). The retrieval team travel to the referring hospital where they work with the local team to stabilise the child before transfer. The team has specialist equipment in an ambulance and, sometimes in a chopper, to enable them to provide high quality mobile intensive care to these children throughout the retrieval process. Currently, approximately 400 children are referred to this service each year of which about half continue to be cared for by their local hospital and half are transported by the retrieval team to base hospital for more advance care (University Hospital Southampton, 2011). Creation of a Paediatric Retrieval Team In 1993 a British Paediatric Association working party concluded that care for critically ill children should be concentrated in paediatric intensive care units. This report was criticised in by the NHS Centre for Reviews and Dissemination because not all areas in the United Kingdom is equipped with an intensive care units as well as the additional expenses that will be charged from the transfer. But eventually did agree on the need for the most severely ill children to be cared for in dedicated paediatric intensive care units. During then, despite a lack of randomised controlled trials, the weight of professional and public opinion has driven National health Services towards the realization of such provision of centralisation, resulting in many extremely ill children being referred to and transported long distances to able hospitals with critical care units. During that time, only around a third of paediatric intensive care units provided specialised retrieval services. A study at Birmingham Children's Hospital, which relied on referring hospitals to provide transfer to the intensive care, found that a significant adverse clinical event occurred during transfer in three out of four children, with events described as life threatening in 20%. On the basis of such reports and speculations, the NHS has decided on the need for specialised retrieval teams that seem to be incontrovertible (Logan, 1995; Sharples et al., 1996). In the past transfer of these children was undertaken poorly in an ad hoc manner or by poorly trained staff with inadequate equipments. Hence during those times these children are exposed to high risks of morbidity as revealed by the number of deaths during such transport. A recent development in providing intensive care for children is the centralization of intensive care facilities for children in tertiary centres that demands a safe and well-organized transport system. In the provision of the said centralization, the transfer of critically ill children from a referring general hospital to a tertiary paediatric intensive care centre is performed by a specially trained and fully equipped transport team. During the transfer of critically ill children continuous intensive care facilities are provided which is available in the retrieval vehicle. The minimal requirements of equipment and materials for transport consists of a monitor allowing continuous measurement of vital signs, a defibrillator, tools for airway management, oxygen source, suction unit, fluid and electrolyte management, medications, resuscitation chart and a communication system to facilitate important data during the transfer. Basically it is a mobile paediatric intensive care unit constructed with the right equipment, including easily accessible ventilator and materials, optimized for close patient observation and ventilator control (Vos et al. 2003). Patient transport and retrieval is therefore best undertaken by trained and appropriate skilled personnel using dedicated equipment to decrease the chances of morbidity and mortality during the transport. The aim of the retrieval service is to provide the critical child with an intensive care as soon as possible and to deliver safely in an appropriate facility the soonest possible time for continuation of intensive critical care (Berry et al. 2010). Retrieval staff needs to be chosen carefully for both medical and nursing staffs to do the retrieval process. These personnel should be trained and certified to facilitate the transfer properly and most importantly to ensure safety of the patient. It must be understood that the success rate of the paediatric retrieval team lies fully in the competency and efficiency of the members to execute the job affectively (Barry et al, 2010). Although paediatric retrieval is highly recognized in the field of healthcare in giving safe transport to patients still the transfer process is a high risk activity both for patients and the retrieval team. The risk of transfer includes: Deranged physiology worsened by movement, leading to cardio respiratory instability; cramped condition, road traffic accidents involving the ambulance, equipment as well as staff exhaustion and the psychological pressure taken by the team to safely deliver the ill child in the receiving facility for further treatment (Barry et al., 2010). Typical equipment needed during transport present inside an ambulance of the paediatric retrieval team includes: Trolley; incubator; system to secure ventilator, pumps, monitors; safety system to secure patient in transfer; equipment bags; multiple compartment to allow access to individual items without unpacking them; and drug boxes (Barry et al., 2010). Equipment per retrieval team also varies in adult and paediatric retrieval service as specialist neonatal transport teams have also evolved but all these services even if they vary face the same issues. One of these is to ensure that retrieval team ambulance must deploy the correct equipment in the correct vehicle. IN example, a common misconception is that equipment used in neonatal units can be simply adapted by transport teams for use in road vehicles and aircraft. There are many regulations that apply to the carriage of intensive care incubators and ancillary equipment, and this is an essential task of those delegated with the responsibility of procurement for transport (McGrory et al., 2011). The preference for products will be individual to different teams. As well as considering the product features, the retrieval team must also research maintenance schedules, procurement costs and ongoing expenditure of consumables (McGrory et al., 2011). The importance of these products is significant in giving advance care to the critical patient during transport thus failure or exhaustion of an equipment is never an option for the retrieval team for it can highly compromise the safety of the patient hence proper monitoring and maintenance of such equipment is necessary that it will be at its best during any patient transfer. Members of the team Good personnel are the most valuable part of a transport team because without these significant people success or even the realization of the transport will never happen. The National Service Framework for Children, Young People and Maternity Services (NSF) states that children and young people should receive appropriate high quality, evidence-based hospital care, delivered by staff who possess the right set of skills (Solomon & Clark 2009). Members of the paediatric retrieval team are basically consisting of the following: The Medical Director, usually a Paediatric or Neonatal Intensive Care unit consultant, develops policies and protocols for the team to follow ensuring proper flow of the team activities. Also reviews and approves equipment and medication and manages quality improvement programmes based on the assessment and reviews of the transport cases (Barry et al., 2010). Retrieval Coordinator, a senior nurse, share common responsibilities with the medical director in developing policies and protocols, quality improvement programmes and budget management (Barry et al., 2010). Transport fellow and nurses on the other hand are consisting of experienced nurses in the field of paediatric and neonatal intensive care unit as well as trainings and certification in rescue and resuscitation for such cases and can be available 24/7 for the possibility of having retrieval or transport regardless of time (Barry et al., 2010). Nurse-led paediatric retrieval team: A modern day approach Traditionally in the United Kingdom, the transportation of the critically ill child to a paediatric intensive care unit has been carried out by a medically led team of doctors and nurses. It is a common notion that in the old health care setting physicians are always on the lead in terms of treatment to the patient. However due to modernization and advancement in professional skills, in other countries such as the United States of America and Canada, appropriately trained nurse practitioners have proven to be competent in the transportation of critically ill children. This nurse-led team model has also been shown to be successful in the speciality of neonatal care in the United Kingdom. This leap has lead to the advancement in the scope of the nursing practice and has become an independent figure in the heath care arena (Davies & Lynch, 2007). The impact of changes in the National Health Service (NHS) has led to an increased demand for the transportation of the child requiring paediatric intensive care, the lifting of restrictions and expanding the scope on nursing practice and the reduction of doctors’ hours in keeping with the European Working Time Directive. This way the shortage of physicians from retrieving hospital will be limited and can work on other matters other than being on the retrieval team since the position previously assumed by physicians only are now given under the care of competent nurses. This has led to one NHS Trust in the United Kingdom developing the role of paediatric retrieval nurse practitioners (RNP): who are competent and well trained nurses that lead the retrieval team (Davies & Lynch, 2007). Significance of Paediatric retrieval The significance of retrieval team is not only limited to the safety of the critical child. The significance extends to both the referring and receiving hospital facility as well as the staff and their equipments for it buys them ample time to prepare manpower, materials and equipments necessary for the case of the critically ill child thus it saves time, effort and unnecessary expenditure. The national government also shares in the significance of retrieval system by decreasing the number morbidity in the critically ill child especially during transport. To note on the significance of paediatric retrieval in the health care field is to note on the different studies made to analyze and prove the favourable effects based on facts and researched data. Thus by citing such credible studies the importance of paediatric retrieval is backed up with studies with varying results in favour of retrieval service and not just mere sayings. In a study made to audit paediatric intensive transfer activity and transfer-related adverse events in a resource-limited setting. In this one-year prospective audit of all children transferred directly from other hospitals, data were collected for patient demographics, diagnostic category, referring hospital, transferring personnel, mode of transport, and technical, clinical, and critical adverse events. The transfer of 202 children, with median age 2.8 months were analysed (Hatherill et al., 2003). It has been found out that most transfers were performed by paramedic personnel via road ambulance consisting of 82% wherein one or more technical adverse events occurred in 36%, clinical adverse events in 27%, and critical adverse events in 9% of children. On the other hand, retrievals by intensive care staff consist only 10% of all the transfers but had a significantly no incidence of technical adverse events that had happened. Children transferred from non-academic hospitals within the metropolitan area had the highest incidence of technical (44%), clinical (39%), and critical (17%) adverse events. Crude mortality was 17%. Having these figures it can be concluded that here is a high incidence of transfer-related adverse events in transfers made by non-paediatric retrieval team. This could be accounted to efficiency of personnel and equipment during the transfer, the less trained the team to transfer patient the higher the risk of developing adverse effects during the conduct (Hatherill et al., 2003). In a study done by Vos et al. (2004) to compare the effectiveness of having a retrieval team against transport with none trained specialist entitled ‘Comparison of inter-hospital paediatric intensive care transport accompanied by a referring specialist or a specialist retrieval team,’ a prospective observational clinical study was made on 249 intensive paediatric care transport. The data collection were based on comparison of patient characteristics, interventions before and directly after transport, complications that have arisen and the kind of equipments available during the transport. The result of the study have shown that inter-hospital transports accompanied by referring specialists had a longer average transport time of 74.6 minutes versus 60.2 minutes, higher incidence of respiratory insufficiency of 56.9% against 41.1%, and lower incidence of circulatory insufficiency of 27.0% versus 41.1% than primary admission diagnoses. These transports had a lower percentage of ventilatory support of 47.4% against 72.3%, higher need for acute interventions directly upon arrival on the paediatric ICU, and higher incidence of critical and serious complications. In 75% of the transfers accompanied by retrieval teams interventions before the transport were deemed to be necessary. During the transports accompanied by referring specialists the equipment and materials available proved rather limited (Vos et al., 2004). Therefore the result of this study proves that paediatric retrieval team on critically ill patient transport is significant to the safety of the patient because during paediatric intensive care transports accompanied by none trained referring specialists there appears to be a higher incidence of complications, specialized equipment is more often not available, and more acute interventions are required upon arrival in the paediatric ICU (Vos et al., 2004). The coming of the paediatric retrieval as a result of the need to address the needs of a critically ill child is timely. By the virtue of modernization and advance, the health care system is now able to provide intensive care even on the road to fetch ill children from primary hospitals to specialty hospitals for the needed critical care. Of course this kind advancement are not merely based on speculations, because the health care field aims to a practice based on knowledge and backed up with studies to attest its efficacy. That is why more and more studies over the years have proved the edge of having a paediatric retrieval service and some of these studies have been cited in the context of this paper. Although some might say that building and setting up a paediatric retrieval team is costly, indeed it is. First is due to the most advance equipments jam packed into a vehicle wherein everything needed for emergency and resuscitation is present to facilitate safe transfer. Secondly, the trainings and certifications team members have to undergo through to be able to comply with the standards of health care to be able to perform life saving measures when the need arises. On a personal point of view all these costly expenses are nothing compared to the life of many critical ill children which will be given another shot in life and given another chance for a better future because the use of a dedicated, specialist retrieval team has been shown to reduce preventable adverse events during interhospital transport, and can improve the outcome in children admitted to PICU (Entwistle, 2012). References: Barry P., Morris K. & Ali T. (2010) Chapter 18 Transport and Retrieval. Paediatric Intensive Care; Oxford Specialist Handbooks in Paediatrics. Oxford Medical Publications. Oxford University press. 310-330 Davies J. & Lynch F. (2007) Pushing Boundaries in Paediatric Intensive Care: Training as a Paediatric Retrieval Nurse Practitioner. British Association of Critical Care Nurses. 12 (2), 74-80 Entwistle M. (2012) Paediatric retrieval and the Anaesthetist; A better way to maintain paediatric resuscitation skills. E-Brief 2, pp 6-7 Hatherill M., Waggie Z., Reynolds L. & Argent A. (2003) Transport of Critically Ill Children in a Resource-Limited Setting. Intensive care Medicine. 29 (9), 1574-1554 Logan S. (1995) Commentary: Evaluation of specialist paediatric retrieval teams. British Medical Journal, 311, p. 839 McGrory L., McKinlay J., Robertson L., Loch F., Skeoch C. & Hearns S. (2011) Transport and Retrieval: Defining the kit and Caboodle. Buyer’s guide to Respiratory care Products. 90- 112. Solomon J. & Clarke D. (2009) Safe Transport from Specialist paediatric Intensive Care Unit to a referral Hospital. Paediatric Nursing 21(10), 30-34 Peadiatric Intensive Care Audit Network (2011) Annual Report of the Paediatric Intensive Care Audit Network January 2008- December 2010. http://www.picanet.org.uk/Documents/General/Annual%20report%20published%202011/Annual_report_02_12_11v2.pdf Sharples A., O’Niell M. & Dearlove O. (1996) Children are still transferred by non-specialist teams. British Medical Journal. 312, pp. 120-121 South Thames Retrieval Service (2012) South Thames Retrieval Service. http://www.strs.nhs.uk/homepage.aspx University Hospital Southampton (2011) Paediatric Retrievals. http://www.uhs.nhs.uk/OurServices/Intensivecare/PaediatricIntensiveCareUnit/Paediatricretrievals/PaediatricRetrievals.aspx Vos G., Buurman W., van Waardenburg D., Visser T., Ramsay G. & Donckerwolcke R. (2003) Interhospital paediatric intensive care transport: a novel transport unit based on a standard ambulance trolley. European Journal of Emergency Medicine. 10 (3), pp. 195-199 Vos G., Nissen A., Nieman F., Meurs M., van Waardenburg D., Ramsay G. & Donckerwolcke R. (2004) Comparison of interhospital pediatric intensive care transport accompanied by a referring specialist or a specialist retrieval team. Intensive care Medicine, 30 (2), 302-308 West Midlands Specialised Commissioning Group (2009) Transport - Paediatric Retrieval Service. West Midlands Paediatric Retrieval Service. http://www.wmsc.nhs.uk/specialised-services/commissioned-services/transport/ Read More