New Standards for Critically Ill Children: towards a unified approach

Abstract

The new Standards for Critically Ill Children (2010) have just been published. What do these add? First and foremost, these Standards explicitly recognize that the treatment of a critically ill child wherever it first presents requires teamwork, not only between different disciplines within a hospital, but also across different hospitals and specialities across the whole Region. This can only be achieved by recognizing the crucial role that district general hospital (DGH) staff play in the early management of these children. With this in mind, it is envisaged that these Standards will effectively build upon the Department of Health’s guidance: ‘The acutely or critically sick or injured child in the district general hospital: A team response’— Dept of Health (England), 2006—known widely as the ‘Tanner Report’ after the Chair of the Working Party, Prof. Stuart Tanner. Since the last Standards Document regarding Critically Ill Children in 2001, the Working Party has been extended to ensure that as far as possible, the new Standards reflect the views and aspirations of clinicians from all disciplines along this patient journey, both medical and nursing, and those of parent representatives and commissioners as well. Additionally, it has also drawn heavily on the work of the West Midlands Group who for some years have set Standards for Critically Ill Children across that Region but concentrating mainly on DGH clinical areas. Both processes were therefore aligned to synchronize their recommendations. The Working Party membership comprised representatives from the Association of Paediatric Anaesthetists of Great Britain and Ireland, the Royal College of Anaesthetists, the British Association of Critical Care Nurses, the College of Emergency Medicine, the Intensive Care Society, the Royal College of Nursing, the Royal College of Paediatrics and Child Health, the Royal College of Surgeons, lay representation including Action for Sick Children, Commissioners, the Department of Health, and representatives from the Paediatric Intensive Care Society. In the final stages of its production, a joint Foreword was signed by the Presidents of the Royal College of Anaesthetists, the Royal College of Paediatrics and Child Health, the College of Emergency Medicine, the Intensive Care Society, and the Chief Executive of the Royal College of Nursing. It is hoped that these new Standards will achieve a set of realistic and achievable standards across all the areas where critically ill children present and consider the care needed in a journey starting in the Emergency Department or Children’s ward areas, through to HDU, the General ICU, and then retrieval or other transfer to a Paediatric Intensive Care Unit (PICU). All regions should have a clear Network led by a Tertiary Centre Paediatric Intensive Care Unit or, possibly, by the larger amalgamated Retrieval Services that are being increasingly commissioned. These Networks should bring together emergency department clinicians, paediatric ward nurses, paediatricians, anaesthetists, intensivists, surgeons, retrieval teams, ICU and PICU nurses, physiotherapists, and pharmacists. This network would benefit from including hospital and commissioning management. To understand the place of the Standards in today’s practice, it would be useful to review recent history.