Yorkshire & Humber Paediatric Critical Care ODN
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1 Yorkshire & Humber Paediatric Critical Care ODN Presentation to Specialised Commissioning Oversight Group Thursday 3 May 2018
2 Introduction to Paediatric Critical Care Sian Cooper Consultant Paediatric Intensivist Clinical Lead (North) Yorkshire & Humber PCC ODN
3 What is Paediatric Critical Care? Pathway of care for the very sick child Initial recognition Resuscitation and stabilisation Transport High dependency care Intensive care
4 Tertiary Units High dependency care Intensive care Important links to other specialist paediatric services Significant interdependencies
5 District Generals Recognition of sick child Resuscitation and stabilisation High dependency care
6 How is PCC Classified? HRG Band Critical care levels Commiss ioning Definition XB07Z Level 1 CCG HDU level 1 - Basic critical care (including monitoring, O2 by mask) XB06Z Level 2 NHS Eng HDU level 2 Intermediate critical care (including CPAP, BiPAP by mask) XB05Z Level 3 NHS Eng PIC level 1 Advanced critical care (level 1) (includes simple invasive ventilation / single organ failure) XB04Z Level 4 NHS Eng PIC level 2 Advanced critical care (level 2) XB03Z Level 5 NHS Eng PIC level 3 Advanced critical care (level 3) XB02Z Level 6 NHS Eng PIC level 4 Advanced critical care (level 4) XB01Z Level 7 NHS Eng PIC level 5 Advanced critical care (level 5)
7 Why a Network approach Concepts of Critical Care Levels 1-3
8
9 The case for change Inequity across the UK Staffing resources, training and competence, bed capacity Inconsistent funding models Poorly described pathways for PCC Many areas without formal Networks
10 Child and family Best care Close to home
11 Classification Commissioning and designation Configuration PCC ODN Audit and governance Child and family Best care Close to home Clinical pathways and transport Measuring activity and outcomes Standards and quality Workforce
12
13 Clinical pathways Step-up and step-down between CC levels System to facilitate this Advice, decision support, triage and transportation Agree pathways and trigger points taking into account geographical and other factors
14 Transport Existing services responsible for advice, decision support and triage to CC network Includes children requiring Level 1 / Level 2 CC and where necessary transporting child to appropriate area Should be commissioned appropriately
15 Service and system review Education, training and shared learning Communication and engagement Winter and emergency planning Y&H PCC ODN Governance and risk Capacity, demand and contracting Guidelines Quality and performance monitoring
16 Setting standards and defining quality PICS quality standards for the care of critically ill children 5 th edition 2015 allow benchmarking of all PCCUs Governance responsibility for delivery of safe, high quality CC lies principally with individual service providers, supported by Local Area Team and the PCC ODN
17 Service Evaluation Level 1, 2 & 3 PCC in Y&H Karen Perring Lead Nurse Yorkshire & Humber PCC ODN
18 Issues Outcomes Lack of current activity data available Inconsistent funding Staffing levels needed unachievable Lack of staff with appropriate training and competencies Document seen as aspirational The Y&H PCCODN to coordinate a data collection exercise using PCCMDS Service Evaluation of each Paediatric Unit across the region against level 1 and 2 standards
19 HDU Audit 3 audits completed 1 month period in Winter month period Winter month CQUIN Jul Dec form completed for each child receiving any of the listed interventions for longer than 4 hours. PCCMDS 2011 used for first two then 2016 used for CQUIN
20 Results % response rate 694 forms included in audit From DGHs Level bed days CPAP 76 bed days HF 207 bed days % response rate 1197 forms included in audit From DGHs Level bed days CPAP 133 bed days HF 407 bed days
21 CQUIN Audit 2017 Ran from July 1st December 31st 100% Response rate 1468 forms included? due to change in PCCMDS Level 2 bed days DGH units out of 15 doing CPAP (excluding tertiary centres) = 154 bed days 11 units were delivering high flow during the audit period and 2 more have since started it = 825 bed days.
22 Service Evaluation Based on The Paediatric Intensive Care Society Quality Standards for the Care of Critically Ill Children December standards used. These standards Build on the 2010 standards Reflect the guidance in High Dependency Care for Children Time to Move On (RCPCH, 2014) and Facing the Future (RCPCH, 2015).
23 Emerging themes 16 completed + 2 PICU Medical Staffing middle grade gaps esp level 2 Nursing Shortage of paediatric nurses with Advanced Life Support skills on Paediatric wards Nursing staff competencies for critical care skills passport Local data collection - limited In hospital Transfer Guidelines Psychological support for families
24 What is the ODN doing to support? Regional Education Programme Delivered by ODN to local hospital sites Multi-disciplinary Simulation Training Nurse Skills Study days Share good practice from around the region Regional guidelines Clinical forums (e.g. Hi flow, sepsis, status) Share competency package for local implementation Results share with Commissioners
25 Challenges Ahead Vision for services in Yorkshire & Humber Jeff Perring Consultant Paediatric Intensivist Clinical Lead (South) Yorkshire & Humber PCC ODN
26 Proposed Recommendations for the commissioning and designation of units All PCC activity should be commissioned as CC activity and be seen as separate from routine care Agreement needs to be reached between NHS England and Clinical Commissioning Groups (CCGs) regarding how PCC activity is commissioned and funded Draft service specification incorporating Level 1 and 2 CC is proposed
27 PCC ODN Strengths Successful (exemplar) Two centres Clinical leadership Network engagement Strong team Education and training Work completed (HDU / escalation etc) Hosted organisation Weaknesses Long term funding stream Joint commissioning (CCG & NHS-E) Limited clinical time Accommodation Threats Changing climate (NHS-E + NHS-I) Disparity of PIC ODNs nationally
28 Potential Future Roles and Responsibilities of a PCC ODN Collaboration with commissioning team to designate the Level 1 / Level 2 / Level 3 PCCUs across the network Develop pathways Level 1 / 2 / 3 CC Long term ventilation Transport ECMO
29 Monitoring of adherence to standards including staffing levels and training / competencies PCC ODN should co-ordinate collection of activity through collection of PCCMDS across all PCCUs in the Network Align with neonatal and adult CC ODNs
30 Opportunities Whole pathway approach to critical care PIC review Local implementation of national policy Networked approach Regional development work ICS / STP Partnership working (Y&H) Wider region Greater North East (Y&H + NE) Specific areas Designation of level 2 units, LTV, winter pressure Other specialised services e.g. Paediatric surgery New accommodation (with Embrace)
31 Next steps Work with NHS-E to define ways forward Response to National PIC review Understand resource implications of new roles/responsibilities Including economies of scale Support providers in areas of partnership working Within remit of ODN Provide independent voice to STP / ICS work Local work accommodation needs & potential sites
32 Any questions?
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