Caring For Patients With Congenital Heart Disease – A Nationwide Survey Of Nurses’ Educational Needs

Descriptio

A qualitative study exploring risk perception in congenital cardiac surgery: the perspective of UK surgeons

Introduction:Managing risk is central to clinical care, yet most research focuses on patient perception, as opposed to how risk is enacted within the clinical setting by healthcare professionals.Aim:To explore how surgical risk is perceived, encountered, and managed by congenital cardiac surgeons.Methods:Semi-structured interviews were conducted with 20 congenital cardiac surgeons representing every unit across England and Wales. All interviews were transcribed verbatim, with analysis based on the constant comparative approach.Findings:Three themes were identified, reflecting the interactions between personal, institutional, and political context in which risk is encountered and managed. First, “communicating risk” highlights the complexity and variability in methods employed by surgeons to balance legal/moral obligations with parental need and expectations. Universally, surgeons described the need for flexibility in their approach in order to meet the needs of individual patients. Second, “scrutiny and accountability” captures the spectrum of opinion arising from the binary nature of the outcomes collated and the way in which they are perceived to be interpreted. Third, “nature of the job” highlights the personal and professional implications of conveying and managing risk and the impact of recent policy changes on the way this is enacted.Conclusion:Variations in approaches to communicating risk demonstrate a lack of consensus, compounded by insufficient evidence to determine or monitor a “best-care” approach. With current surgical outcomes suggesting little room for increasing survival rates, future care needs should shift to the “soft skills” in order to continue to drive improvements in parental and patient experience.</div

Using a genetic algorithm to solve a non-linear location allocation problem for specialised children's ambulances in England and Wales

Since 1997, special paediatric intensive care retrieval teams (PICRTs) based in 11 locations across England and Wales have been used to transport sick children from district general hospitals (DGHs)to one of 24 paediatric intensive care units (PICUs). The national quality standard says that a PICRT should arrive at a patient’s bedside within 3 hours from accepting the referral. In this paper we develop a location allocation optimisation framework to help inform decisions on the optimal number of locations for each PICRT, where those locations should be, which local hospital each location serves and how many teams should station each location. Our framework allows for stochastic journey times, differential weights for each journey leg and incorporates queuing theory by considering the time spent waiting for a PICRT to become available (if all teams are away fromthe base when a referral comes in). A two-stage genetic algorithm is used to solve the resultingnonlinear optimisation problem and the optimal locations of PICRT stations and the allocation ofDGHs are obtained based on available data. An additional problem with this optimisation is how to distribute a given number of teams, with which we applied a greedy algorithm. We examine the average waiting time and the average time to bedside under different number of operational PICRT stations, different number of teams per station and different levels of demand. We show that consolidating the teams into fewer stations for higher availability leads to better performance and only with a level of guaranteed availability will the geographic advantage of more stations further improve performance

Impact on 30-day survival of time taken by a critical care transport team to reach the bedside of critically ill children

[First paragraph] Following centralisation of paediatric intensive care in England and Wales, nearly 5000 critically ill children are transported from local hospitals to paediatric intensive care units (PICUs) annually. The majority of transports are performed by ten regionally based paediatric critical care transport teams (PCCTs) [1]. As arrival of the PCCT represents the first interaction these children have with specialist paediatric critical care, a key standard set by the national Paediatric Intensive Care Society (PICS) [2] is that a PCCT should arrive at the child’s bedside within three hours of agreeing they require PICU admission (referred to as ‘time-to-bedside’).</p

Understanding the co-construction of safety in the paediatric intensive care unit: a meta-ethnography of parents’ experiences

Background Children experiencing critical illness or injury may require admission to a paediatric intensive care unit (PICU) to receive life-sustaining or life-saving treatment. Studies have explored the experience of parents with a child in PICU but tend to focus on subgroups of children or specific healthcare systems. Therefore, we aimed to undertake a meta-ethnography to draw together the published research. Methods A systematic search strategy was developed to identify qualitative studies, which had explored the experiences of parents with a critically ill child treated in a PICU. A meta-ethnography was undertaken following the structured steps of identifying the topic; undertaking a systematic search; reading the research; determining how the studies relate and translate into each other; and synthesising and expressing the results. Results We identified 2989 articles from our search and after a systematic series of exclusions, 15 papers remaining for inclusion. We explored the original parent voices (first order) and the interpretation of the study authors (second order) to identify three third-order concepts (our interpretation of the findings), which related to technical, relational and temporal factors. These factors influenced parents' experiences, providing both barriers and facilitators to how parents and caregivers experienced the time their child was in the PICU. The dynamic and co-constructed nature of safety provided an analytical overarching frame of reference. Conclusion This synthesis demonstrates novel ways in which parents and caregivers can contribute to the vital role of ensuring a co-created safe healthcare environment for their child when receiving life-saving care within the PICU.</p

Children born preterm admitted to paediatric intensive care for bronchiolitis: A systematic review and meta-analysis

Background To undertake a systematic review of studies describing the proportion of children admitted to a paediatric intensive care unit (PICU) for respiratory syncytial virus (RSV) and/or bronchiolitis who were born preterm, and compare their outcomes in PICU with children born at term. Methods We searched Medline, Embase and Scopus. Citations and references of included articles were searched. We included studies published from the year 2000 onwards, from high-income countries, that examined children 0–18 years of age, admitted to PICU from the year 2000 onwards for RSV and/or bronchiolitis. The primary outcome was the percentage of PICU admissions born preterm, and secondary outcomes were observed relative risks of invasive mechanical ventilation and mortality within PICU. We used the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies to assess risk of bias. Results We included 31 studies, from 16 countries, including a total of 18,331 children. Following meta-analysis, the pooled estimate for percentage of PICU admissions for RSV/bronchiolitis who were born preterm was 31% (95% confidence interval: 27% to 35%). Children born preterm had a greater risk of requiring invasive ventilation compared to children born at term (relative risk 1.57, 95% confidence interval 1.25 to 1.97, I2 = 38%). However, we did not observe a significant increase in the relative risk for mortality within PICU for preterm-born children (relative risk 1.10, 95% confidence interval: 0.70 to 1.72, I2 = 0%), although the mortality rate was low across both groups. The majority of studies (n = 26, 84%) were at high risk of bias. Conclusions Among PICU admissions for bronchiolitis, preterm-born children are over-represented compared with the preterm birth rate (preterm birth rate 4.4% to 14.4% across countries included in review). Preterm-born children are at higher risk of mechanical ventilation compared to those born at term.</p

Is parental presence in the ambulance associated with parental satisfaction during emergency paediatric intensive care retrieval?: a cross-sectional questionnaire study

Objectives:  Quality standards for pediatric intensive care transport services in the U.K. state that at least one parent should be allowed to travel with their child during emergency transport to a PICU. We aimed to identify the reasons why parents do, or do not, accompany their child and whether there is an association between parental presence in the ambulance and their satisfaction with the transport. Design:  National cross-sectional parent questionnaire. Setting:  Pediatric Critical Care Transport (PCCT) teams and PICUs in England and Wales. Participants:  Parents of children transferred to one of 24 participating PICUs between January 2018 and January 2019. Interventions:  None. Measurements and Main Results:  A parent feedback questionnaire was completed by parents whose child received an emergency interhospital transfer. As part of the questionnaire, a brief nine-item scale was developed to summarize parental transport experience (ranging from 1 to 5). The association between parental presence in the ambulance and parental experience was analyzed. A total of 4,558 children were transported during the study. Consent was obtained from 2,838 parents, and questionnaires received in 2,084 unique transports (response rate: 45.7%). In 1,563 transports (75%), at least one parent traveled in the ambulance. Parents did not travel in 478 transports (23%) and, in most instances (442 transports; 93%), offered reasons (emotional, practical, and health-related) for declining to travel or explanations why they were not permitted to travel (mainly due to space restrictions). Most parents rated their experience with the retrieval teams very highly, and within this context, we found evidence of greater variability in experience ratings if parents were not present in the ambulance and if this was not their choice. Conclusions:  Most parents who completed questionnaires rated their experience with their PCCT team highly. Parental presence and choice to travel in the ambulance were associated with a more positive experience.</p

Impact of prematurity on long-stay paediatric intensive care unit admissions in England 2008-2018

Background Survival following extreme preterm birth has improved, potentially increasing the number of children with ongoing morbidity requiring intensive care in childhood. Previous single-centre studies have suggested that long-stay admissions in paediatric intensive care units (PICUs) are increasing. We aimed to examine trends in long-stay admissions (≥28 days) to PICUs in England, outcomes for this group (including mortality and PICU readmission), and to determine the contribution of preterm-born children to the long-stay population, in children aged Methods Data was obtained from the Paediatric Intensive Care Audit Network (PICANet) for all children Results There were 99,057 admissions from 67,615 children. 2,693 children (4.0%) had 3,127 long-stays. Between 2008 and 2018 the annual number of long-stay admissions increased from 225 (2.7%) to 355 (4.0%), and the proportion of bed days in PICUs occupied by long-stay admissions increased from 24.2% to 33.2%. Of children with long-stays, 33.5% were born preterm, 53.5% were born at term, and 13.1% had missing data for gestational age. A considerable proportion of long-stay children required PICU readmission before two years of age (76.3% for preterm-born children). Observed mortality during any admission was also disproportionately greater for long-stay children (26.5% for term-born, 24.8% for preterm-born) than the overall rate (6.3%). Conclusions Long-stays accounted for an increasing proportion of PICU activity in England between 2008 and 2018. Children born preterm were over-represented in the long-stay population compared to the national preterm birth rate (8%). These results have significant implications for future research into paediatric morbidity, and for planning future PICU service provision.</p

Paediatric intensive care admissions of preterm children born <32 weeks gestation: a national retrospective cohort study using data linkage

Objective Survival of babies born very preterm ( Design Retrospective cohort study, using data linkage of National Neonatal Research Database and the Paediatric Intensive Care Audit Network datasets. Setting All neonatal units and PICUs in England and Wales. Patients Children born very preterm between 1 January 2013 and 31 December 2018 and admitted to neonatal units. Main outcome measures Admission to PICU after discharge home from neonatal care, before 2 years of age. Results Of the 40 690 children discharged home from neonatal care, there were 2308 children (5.7%) with at least one admission to PICU after discharge. Of these children, there were 1901 whose first PICU admission after discharge was unplanned. The percentage of children with unplanned PICU admission varied by gestation, from 10.2% of children born Following adjustment, unplanned PICU admission was associated with lower gestation, male sex (adjusted OR (aOR) 0.79), bronchopulmonary dysplasia (aOR 1.37), necrotising enterocolitis requiring surgery (aOR 1.39) and brain injury (aOR 1.42). For each week of increased gestation, the aOR was 0.90. Conclusions Most babies born <32 weeks and discharged home from neonatal care do not require PICU admission in the first 2 years. The odds of unplanned admissions to PICU were greater in the most preterm and those with significant neonatal morbidity.</p

Estimated neonatal survival of very preterm births across the care pathway: a UK cohort 2016-2020

Objective Currently used estimates of survival are nearly 10 years old and relate to only those babies admitted for neonatal care. Due to ongoing improvements in neonatal care, here we update estimates of survival for singleton and multiple births at 22+0 to 31+6 weeks gestational age across the perinatal care pathway by gestational age and birth weight. Design Retrospective analysis of routinely collected data. Setting A national cohort from the UK and British Crown Dependencies. Patients Babies born at 22+0 to 31+6 weeks gestational age from 1 January 2016 to 31 December 2020. Interventions None. Main outcome measures Survival to 28 days. Results Estimates of neonatal survival are provided for babies: (1) alive at the onset of care during the birthing process (n=43 763); (2) babies where survival-focused care was initiated (n=42 004); and (3) babies admitted for neonatal care (n=41 158). We have produced easy-to-use survival charts for singleton and multiple births. Generally, survival increased with increasing gestational age at birth and with increasing birth weight. For all births with a birthweight over 1000 g, survival was 90% or higher at all three stages of care. Conclusions Survival estimates are a vital tool to support and supplement clinical judgement within perinatal care. These up-to-date, national estimates of survival to 28 days are provided based on three stages of the perinatal care pathway to support ongoing clinical care. These novel results are a key resource for policy and practice including counselling parents and informing care provision.</p