Pathways to care for critically ill or injured children: A cohort study from first presentation to healthcare services through to admission to intensive care or death

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dc.contributor.authorHodkinson, Peteren_ZA
dc.contributor.authorArgent, Andrewen_ZA
dc.contributor.authorWallis, Leeen_ZA
dc.contributor.authorReid, Steveen_ZA
dc.contributor.authorPerera, Rafaelen_ZA
dc.contributor.authorHarrison, Sianen_ZA
dc.contributor.authorThompson, Matthewen_ZA
dc.contributor.authorEnglish, Mikeen_ZA
dc.contributor.authorMaconochie, Ianen_ZA
dc.contributor.authorWard, Alisonen_ZA
dc.date.accessioned2016-03-08T10:53:52Z
dc.date.available2016-03-08T10:53:52Z
dc.date.issued2016en_ZA
dc.description.abstractPurpose Critically ill or injured children require prompt identification, rapid referral and quality emergency management. We undertook a study to evaluate the care pathway of critically ill or injured children to identify preventable failures in the care provided. METHODS: A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation to healthcare services until paediatric intensive care unit (PICU) admission or emergency department death, using expert panel review of medical records and caregiver interview. Main outcomes were expert assessment of overall quality of care; avoidability of severity of illness and PICU admission or death and the identification of modifiable factors. RESULTS: The study enrolled 282 children, 252 emergency PICU admissions, and 30 deaths. Global quality of care was graded good in 10% of cases, with half having at least one major impact modifiable factor. Key modifiable factors related to access to care and identification of the critically ill, assessment of severity, inadequate resuscitation, and delays in decision making and referral. Children were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 185 (74%) of children, and death prior to PICU admission was avoidable in 17/30 (56.7%) of children. CONCLUSIONS: The study presents a novel methodology, examining quality of care across an entire system, and highlighting the complexity of the pathway and the modifiable events amenable to interventions, that could reduce mortality and morbidity, and optimize utilization of scarce critical care resources; as well as demonstrating the importance of continuity and quality of care.en_ZA
dc.identifier.apacitationHodkinson, P., Argent, A., Wallis, L., Reid, S., Perera, R., Harrison, S., ... Ward, A. (2016). Pathways to care for critically ill or injured children: A cohort study from first presentation to healthcare services through to admission to intensive care or death. <i>PLoS One</i>, http://hdl.handle.net/11427/17569en_ZA
dc.identifier.chicagocitationHodkinson, Peter, Andrew Argent, Lee Wallis, Steve Reid, Rafael Perera, Sian Harrison, Matthew Thompson, Mike English, Ian Maconochie, and Alison Ward "Pathways to care for critically ill or injured children: A cohort study from first presentation to healthcare services through to admission to intensive care or death." <i>PLoS One</i> (2016) http://hdl.handle.net/11427/17569en_ZA
dc.identifier.citationHodkinson, P., Argent, A., Wallis, L., Reid, S., Perera, R., Harrison, S., ... & Ward, A. (2016). Pathways to care for critically ill or injured children: A cohort study from first presentation to healthcare services through to admission to intensive care or death. PloS one, 11(1). doi:10.1371/journal.pone.0145473en_ZA
dc.identifier.ris TY - Journal Article AU - Hodkinson, Peter AU - Argent, Andrew AU - Wallis, Lee AU - Reid, Steve AU - Perera, Rafael AU - Harrison, Sian AU - Thompson, Matthew AU - English, Mike AU - Maconochie, Ian AU - Ward, Alison AB - Purpose Critically ill or injured children require prompt identification, rapid referral and quality emergency management. We undertook a study to evaluate the care pathway of critically ill or injured children to identify preventable failures in the care provided. METHODS: A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation to healthcare services until paediatric intensive care unit (PICU) admission or emergency department death, using expert panel review of medical records and caregiver interview. Main outcomes were expert assessment of overall quality of care; avoidability of severity of illness and PICU admission or death and the identification of modifiable factors. RESULTS: The study enrolled 282 children, 252 emergency PICU admissions, and 30 deaths. Global quality of care was graded good in 10% of cases, with half having at least one major impact modifiable factor. Key modifiable factors related to access to care and identification of the critically ill, assessment of severity, inadequate resuscitation, and delays in decision making and referral. Children were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 185 (74%) of children, and death prior to PICU admission was avoidable in 17/30 (56.7%) of children. CONCLUSIONS: The study presents a novel methodology, examining quality of care across an entire system, and highlighting the complexity of the pathway and the modifiable events amenable to interventions, that could reduce mortality and morbidity, and optimize utilization of scarce critical care resources; as well as demonstrating the importance of continuity and quality of care. DA - 2016 DB - OpenUCT DO - 10.1371/journal.pone.0145473 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Pathways to care for critically ill or injured children: A cohort study from first presentation to healthcare services through to admission to intensive care or death TI - Pathways to care for critically ill or injured children: A cohort study from first presentation to healthcare services through to admission to intensive care or death UR - http://hdl.handle.net/11427/17569 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0145473en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/17569
dc.identifier.vancouvercitationHodkinson P, Argent A, Wallis L, Reid S, Perera R, Harrison S, et al. Pathways to care for critically ill or injured children: A cohort study from first presentation to healthcare services through to admission to intensive care or death. PLoS One. 2016; http://hdl.handle.net/11427/17569.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Emergency Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2016 Hodkinson et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherChildrenen_ZA
dc.subject.otherPediatricsen_ZA
dc.subject.otherQuality of careen_ZA
dc.subject.otherCritical care and emergency medicineen_ZA
dc.subject.otherHealth care facilitiesen_ZA
dc.subject.otherChild healthen_ZA
dc.subject.otherQuality of lifeen_ZA
dc.subject.otherResuscitationen_ZA
dc.titlePathways to care for critically ill or injured children: A cohort study from first presentation to healthcare services through to admission to intensive care or deathen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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