Abstract
PurposeCritically 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.MethodsA 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.ResultsThe 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.ConclusionsThe 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.
Highlights
The ideal healthcare system would identify sick children early in their illness, and provide treatment that is safe, effective, patient centred, efficient, timely and equitable [1]
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
Children were transferred with median time from first presentation to PICU admission of 12.3 hours
Summary
The ideal healthcare system would identify sick children early in their illness, and provide treatment that is safe, effective, patient centred, efficient, timely and equitable [1]. Highlighting foci for effective quality improvement interventions in paediatric emergencies has the potential to provide significant benefit, especially in resource poor settings where the need is greatest, and the health services poorest [4], and in more affluent countries where delivery of recommended care may still be very difficult [5]. There have been improvements in healthcare for mothers and children in the UK, which many attribute substantially to the CEMACH findings and recommendations [8,9,10,11], and widespread use of this process in other settings [12,13,14,15,16,17,18], such that it is widely regarded as a framework for mortality review
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
