Paediatric Intensive Care Network – A Territory Wide Bottom-Up Referral System

Abstract Description

Proposed Topic (Most preferred): :

Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)

Authors (including presenting author) :

REPRESENTATIVES FROM ALL PAEDIATRICS DEPARTMENT IN HOSPITAL AUTHORITY

Affiliation :

REPRESENTATIVES FROM ALL PAEDIATRICS DEPARTMENTS IN HOSPITAL AUTHORITY

Introduction :

Critically ill patients require timely intervention and support to reverse disease progression. Early stabilization and management at the regional hospital closest to the A&E is paramount to improving patient outcomes.

Objectives :

To review and evaluate the effectiveness of the integrated PICU network with regional and bottom-up referral system

Methodology :

Given the shortage of manpower and PICU beds, an inter-hospital referral system for PICU was established in December 2012 with two updated protocols since then. Under the system, PICU services are networked into four regions supporting each other in a bottom-up referral system. The HKCH PICU will support the cluster PICUs in a hub-and-spoke service model, especially the ECMO service, which is centralized in HKCH. Data on admission and referral from eight regional PICU were analyzed from April 2018 to March 2023 from CDARS. With the commencement of HKCH PICU in 2019, nine PICU data were included from 2019 onwards.

Result & Outcome :

There are 58 PICU beds as of 2023. Eight regional PICUs are at QEH, KWH, PMH, TMH, PWH, PYNEH, QMH and UCH. HKCH PICU started service in 2019. Total admissions to PICU in 18/19, 19/20, 20/21, 21/22 and 22/23 were 1848, 1730, 1565, 1954 and 2008 respectively. Direct admissions from A&E to the PICUs were 225 (12.2%), 237 (13.7%), 193 (12.3%), 316 (16.2%) and 342 (17.0%) respectively. There is no A&E direct admission to HKCH PICU. Admissions from other hospitals, including private hospitals, were 135 (7.3%), 123 (7.1%), 154 (9.8%), 166 (8.5%), and 217 (10.8%). HKCH PICU received referrals from other regional PICUs, too. Overall, number of deaths were 32 (1.7%), 42 (2.4%), 35 (2.2%), 35 (1.8) and 36 (1.8). There was a slight increasing trend in the PICU admission over the past few years, from 12.2% to 17.0 %. Excluding the statistics from HKCH, the regional PICU admissions were 1848, 1480, 1189, 1498, and 1467, respectively, and have been stable in the last two years. The admission directly from regional A&E did not drop but increased from 12.2% to 17.0%.



Conclusion

The PICU network arrangement has facilitated the inter-hospital transfer of patients needing intensive care within or across the regions. With each region's joint effort and mutual support, we have fully utilized the current PICU beds to prevent children from being deprived of intensive care. The network provides a stable PICU service during the COVID-19 pandemic and will serve as a model for future disaster contingency.