732 An audit of admission into a high-dependency unit of a large district general hospital. Is there compliance with national guidance?
Published Date: 19th June 2023
Publication Authors: Kayode-Awe O, Garr R
Abstract
Objective To audit the reasons for admission to the Paediatric high dependency unit (PHDU) using the Paediatric critical care society (PCCS) criteria for PHDU admission (1). To review the demography of children admitted and the duration of admission.
Method
This was a retrospective audit of children < 18 years old admitted to our PHDU over 12 months period from January 2022 to December 2022. We collected anonymised data from the hospital’s electronic data management system (EDMS). The data was compared with the PCCS criteria for level 1 PHDU which includes oxygen use by high flow, nebulised adrenaline in croup, electrocardiograph monitoring, intravenous insulin in diabetic ketoacidosis, reduced level of consciousness and level 2 PHDU which includes non-invasive ventilation and need for intravenous antiepileptic medication.
Result
158 patients were admitted 171 times during the study period (01/01/2022–31/12/2022) of which 101(64%) were male and 57(36%) were female. One hundred and nineteen (70%) were ≤5 years of age (Figure 1). The top three indications for admission include respiratory reasons in 82(47.9%) patients, prolonged seizures in 28(16.4%) patients and diabetic ketoacidosis in 9(5.2%) patients. The mean length of PHDU stay was one night. Most of the patients 146(85.4%) were stepped down to the general paediatric ward. Majority of the patients 100(58.4%) required level 1 care, and 31(18%) required level 2 care (Table 2). However, 40(23%) of the patients admitted did not meet the national guidance criteria for PHDU care. Out of these, 21(52.5%) were cardiovascularly stable patients that needed transfusion of blood or blood products.
Conclusion
Our result shows that as expected most admissions were due to the requirement for respiratory support, with a significant number being less than 5 years of age and making a rapid recovery. The local criteria for admission into the PHDU allow for the admission of children who could be cared for in the general paediatric ward, this suggests a need for a review for admission to reflect national guidance so that resources are dedicated to the care of the critical ill patient that requires PHDU services. The Royal College of Paediatric and Child Health defined three levels of care necessary for critically ill patients (2) These documents standardised the criteria for admission into the high-dependency unit and recommends that facilities be compliant with this evidence-based national guidance.
Kayode-Awe, O; Garr, R. (2023). AN AUDIT OF ADMISSION INTO A HIGH-DEPENDENCY UNIT OF A LARGE DISTRICT GENERAL HOSPITAL. IS THERE COMPLIANCE WITH NATIONAL GUIDANCE. Disease In Childhood. 108(Suppl 2), pp.339-340. [Online]. Available at: https://dx.doi.org/10.1136/archdischild-2023-rcpch.536 [Accessed 3 January 2024].
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