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Alan Monaghan describes how the introduction of a critical care outreach service and a Paediatric Early Warning Score improved management of acutely ill children
KEY WORDS
Intensive care: Paediatric
Patient assessment
Outreach
In the past, paediatric intensive care units (PICUs) were perceived by many as ivory towers. They often had poor relationships with other departments probably caused by them working in isolation, by poor communication and lack of admission and discharge planning. Similar issues in adult critical care resulted in the Department of Health recommending a hospitalwide approach to the identification and referral of critically ill adults (DoH 2000). This led to the development of critical care outreach teams in adult services and an improvement in interdepartmental working.
The function of these outreach teams is to improve the provision of critical care prior to admission to intensive care and following discharge. Across the UK, adult critical care services have been setting up teams under various titles such as emergency medical team or emergency outreach team. Despite the various titles the teams have three shared aims:
* early detection of patients at risk of deterioration
* support and education of ward staff in caring for patients at risk of deterioration
* improved discharge and follow up after intensive care.
This article summarises the process of setting up a paediatric critical care outreach team at Brighton and describes the development of a paediatric early warning score (PEWS) to assist in detecting children at risk of deterioration. The process of implementing change and the difficulties encountered when implementing new working practices are briefly considered. Data from a pilot implementation are presented to provide evidence for use of a paediatric early warning score in children.
Early detection
Early detection and optimal care in the critically ill adult is associated with improved outcomes (DoH 2000), an association that may apply in children. In one review, 61 per cent of paediatric cardiac arrests were caused by respiratory failure and 29 per cent by shock, both of which are potentially reversible causes (Reis et al 2002). Early recognition and appropriate intervention are therefore equally important in children and may prevent the need for admission to intensive care.
There are a number of scoring systems being used to identify adults...