Developing a patient-centred care pathway for paediatric critical care in the Western Cape

 

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dc.contributor.advisor Wallis, Lee en_ZA
dc.contributor.advisor Argent, Andrew en_ZA
dc.contributor.author Hodkinson, Peter William en_ZA
dc.date.accessioned 2016-02-25T12:06:05Z
dc.date.available 2016-02-25T12:06:05Z
dc.date.issued 2015 en_ZA
dc.identifier.citation Hodkinson, P. 2015. Developing a patient-centred care pathway for paediatric critical care in the Western Cape. University of Cape Town. en_ZA
dc.identifier.uri http://hdl.handle.net/11427/17259
dc.description Includes bibliographical references en_ZA
dc.description.abstract Background: Emergency care of critically ill or injured children requires prompt identification, high quality treatment and rapid referral. This study examines the critical care pathways in a health system to identify preventable care failures by evaluating the entire pathway to care, the quality of care at each step along the referral pathway, and the impact on patient outcomes. Methods: A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation until paediatric intensive care unit admission or emergency centre death, using a modified confidential enquiry process of expert panel review and caregiver interview. Outcomes were expert panel assessment of quality of care, avoidability of death or PICU admission and severity at PICU admission, identification of modifiable factors, adherence to consensus standards of care, as well as time delays and objective measures of severity and outcome. Results: The study enrolled 282 children: 85% medical and 15% trauma cases (252 emergency admissions, and 30 children who died at referring health facilities). Global quality of care was graded poor in 57(20%) of all cases and 141(50%) had at least one major impact modifiable factor. Key modifiable factors related to access and identification of the critically ill, assessment of severity, inadequate resuscitation, delays in decision making and referral, and access to paediatric intensive care. Standards compliance increased with increasing level of healthcare facility, as did caregiver satisfaction. Children presented primarily to primary health care (54%), largely after hours (65%), and were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 74% of children, indicating room for improvement. Conclusions and Relevance: The study presents a novel methodology, examining the quality of paediatric critical care across a health system in a middle income country. The findings highlight the complexity of the care pathway and focus attention on specific issues, many amenable to suggested interventions that could reduce mortality and morbidity, and optimize scarce critical care resources; as well as demonstrating the importance of continuity and quality of care throughout the referral pathway. en_ZA
dc.language.iso eng en_ZA
dc.subject.other Emergency Medicine en_ZA
dc.title Developing a patient-centred care pathway for paediatric critical care in the Western Cape en_ZA
dc.type Doctoral Thesis
uct.type.publication Research en_ZA
uct.type.resource Thesis en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Division of Emergency Medicine en_ZA
dc.type.qualificationlevel Doctoral
dc.type.qualificationname PhD en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Hodkinson, P. W. (2015). <i>Developing a patient-centred care pathway for paediatric critical care in the Western Cape</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine. Retrieved from http://hdl.handle.net/11427/17259 en_ZA
dc.identifier.chicagocitation Hodkinson, Peter William. <i>"Developing a patient-centred care pathway for paediatric critical care in the Western Cape."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine, 2015. http://hdl.handle.net/11427/17259 en_ZA
dc.identifier.vancouvercitation Hodkinson PW. Developing a patient-centred care pathway for paediatric critical care in the Western Cape. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Division of Emergency Medicine, 2015 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/17259 en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Hodkinson, Peter William AB - Background: Emergency care of critically ill or injured children requires prompt identification, high quality treatment and rapid referral. This study examines the critical care pathways in a health system to identify preventable care failures by evaluating the entire pathway to care, the quality of care at each step along the referral pathway, and the impact on patient outcomes. Methods: A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation until paediatric intensive care unit admission or emergency centre death, using a modified confidential enquiry process of expert panel review and caregiver interview. Outcomes were expert panel assessment of quality of care, avoidability of death or PICU admission and severity at PICU admission, identification of modifiable factors, adherence to consensus standards of care, as well as time delays and objective measures of severity and outcome. Results: The study enrolled 282 children: 85% medical and 15% trauma cases (252 emergency admissions, and 30 children who died at referring health facilities). Global quality of care was graded poor in 57(20%) of all cases and 141(50%) had at least one major impact modifiable factor. Key modifiable factors related to access and identification of the critically ill, assessment of severity, inadequate resuscitation, delays in decision making and referral, and access to paediatric intensive care. Standards compliance increased with increasing level of healthcare facility, as did caregiver satisfaction. Children presented primarily to primary health care (54%), largely after hours (65%), and were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 74% of children, indicating room for improvement. Conclusions and Relevance: The study presents a novel methodology, examining the quality of paediatric critical care across a health system in a middle income country. The findings highlight the complexity of the care pathway and focus attention on specific issues, many amenable to suggested interventions that could reduce mortality and morbidity, and optimize scarce critical care resources; as well as demonstrating the importance of continuity and quality of care throughout the referral pathway. DA - 2015 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Developing a patient-centred care pathway for paediatric critical care in the Western Cape TI - Developing a patient-centred care pathway for paediatric critical care in the Western Cape UR - http://hdl.handle.net/11427/17259 ER - en_ZA


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