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

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dc.contributor.advisorWallis, Leeen_ZA
dc.contributor.advisorArgent, Andrewen_ZA
dc.contributor.authorHodkinson, Peter Williamen_ZA
dc.date.accessioned2016-02-25T12:06:05Z
dc.date.available2016-02-25T12:06:05Z
dc.date.issued2015en_ZA
dc.descriptionIncludes bibliographical referencesen_ZA
dc.description.abstractBackground: 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.identifier.apacitationHodkinson, 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/11427/17259en_ZA
dc.identifier.chicagocitationHodkinson, 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/11427/17259en_ZA
dc.identifier.citationHodkinson, P. 2015. Developing a patient-centred care pathway for paediatric critical care in the Western Cape. University of Cape Town.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
dc.identifier.urihttp://hdl.handle.net/11427/17259
dc.identifier.vancouvercitationHodkinson 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/11427/17259en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDivision of Emergency Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherEmergency Medicineen_ZA
dc.titleDeveloping a patient-centred care pathway for paediatric critical care in the Western Capeen_ZA
dc.typeDoctoral Thesis
dc.type.qualificationlevelDoctoral
dc.type.qualificationnamePhDen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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