Quantifying high dependency care: a prospective cohort study in Yorkshire (UK).

High dependency care (HDC) is a level of care situated between intensive care and usual ward care with its delivery being independent of location. Inadequate definition makes it problematic to determine the number of children receiving HDC, to identify their care setting and therefore to undertake service planning. We aimed to estimate the volume of hospital inpatient HDC in a geographically defined population using a customised measurement tool in four types of paediatric hospital services (1) tertiary specialist wards, (2) tertiary paediatric intensive care units, (3) district general hospitals (DGHs) general wards and (4) wards at a major acute general hospital. A region-wide prospective cohort study during 2005 collected data to develop a 36-item HDC measurement tool, which then identified children receiving HDC by day and night. The cohort identified 1,763 children as receiving HDC during an admission to 1 of 36 hospital wards in 14 hospitals. HDC was delivered during 9,077 shift periods of 12 h or 4,538 bed days. The volume of care and patient profiles varied by hospital type, within hospital by ward type and by age and season. Tertiary specialist wards and ICUs provided 72% of HDC, with the remainder delivered at the DGHs and the major acute general hospital. The volume of admissions to tertiary specialist wards showed little seasonality and children tended to be older (26% were aged 10-15 years). By comparison, admissions to DGHs were younger with an excess during the winter months. This is the first UK study to quantify HDC from empirical data encompassing all hospital and ward types within a large clinical network. A lack of HDC-designated beds across the region resulted in HDC delivery on all types of hospital wards. The study size and representativeness makes the estimated number of HDC bed days per head of population likely to reflect the wider UK population.

Issues of patient consent: a study of paediatric high-dependency care.

This article reports on the issues relating to obtaining informed, signed consent for a study of paediatric high-dependency care and provides practical guidance on confidentiality for health service researchers. Consent and confidentiality are not new concepts but recent changes to the legislation and guidance offered from nursing and medical regulatory bodies have caused concerns and confusion for researchers with respect to both issues. Balancing health service research and the development of services against the requirements of patients for confidentiality is essential yet challenging. This was a time consuming, costly exercise. Resource implications may ultimately mean that studies which are of benefit to patients in relation to the delivery of their care may not be undertaken. Health professionals need to be continually updated and made aware of the legislation and confidentiality requirements for health service research involving the collection of patient-identifiable details.

A randomised controlled trial of weaning from mechanical ventilation in paediatric intensive care (PIC). Methodological and practical issues.

INTRODUCTION: Most children admitted to the Paediatric Intensive Care Unit (PICU) require assistance with breathing via a mechanical ventilator. Weaning from mechanical ventilation is the transition from ventilatory support to spontaneous breathing. Traditionally weaning has been with the authority of the medical staff. However, current opinion suggests that weaning could be performed by nurses using a standardised protocol [Schultz TR, Lin RJ, Watzman HM, Durning SM, Hales R, Woodson A, et al. Weaning children from mechanical ventilation: A prospective randomised trial of protocol-directed versus physician-directed weaning. Respir Care 2001;46(8):772-82]. The potential advantages of nurse-led (protocol-directed) weaning include: A reduction in weaning time and PICU stay with cost savings. Reduced complications. Improved quality of care. Appropriate use of resources. METHODS: A Randomised Controlled Trial was performed to test the null hypothesis: there is no difference between the clinical effectiveness of nurse-led versus medical-led weaning of infants from mechanical ventilation. Data was collected for 7 infants and analysed. RESULTS: Results indicated no significant differences between the two study groups. Unfortunately due to recruitment problems few inferences can be drawn from the data. CONCLUSION: The trial was unsuccessful due to Recruitment issues. Physical constraints. Impractical entry criteria. Limited randomisation service. Ethical constraints. Barriers to parental participation. The methods, the difficulties encountered and the implications for future research are addressed.