Referral and transfer of the critically ill child

Abstract

### Key points Centralization of paediatric intensive care over the last 20 yr, to lead centres serving a network of referring hospitals, has led to an increase in the numbers of critically ill children being transferred between healthcare institutions in the UK. The majority of these transfers are undertaken by specialist teams, with only 7% conducted by an ad hoc non-specialist team.1 Evidence of fewer critical incidents and improved outcomes after specialist transfer supports this balance of provision.2 However, current capacity and the need for time-critical transfer mean that non-specialists should be prepared to resuscitate, stabilize, refer, and, on occasions, transfer the critically ill child. In recent years, there have been significant changes to the systems in place to refer, transfer, and care for critically ill children. This evolution of paediatric intensive care units (PICU) in the UK dates back to 1996 when the Department of Health, in the face of evidence that centralization of services at larger centres improves patient outcome, set up a national coordinating group. The aim was to outline a strategy to develop and unify the services caring for critically ill children. They initially found an ad hoc service with a lack of structure, training, and staff. There were few specialist transport services and those that did exist were unit-based, bed-dependent, and often not staffed 24/7. Paediatric intensive care services in …