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
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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DOI：
10.1371/journal.pone.0145473
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发表时间：
2016-01-05
期刊：
影响因子：
3.7
通讯作者：
Ward, Alison
中科院分区：
文献类型：
--
作者：
Hodkinson, Peter;Argent, Andrew;Ward, Alison
重症或受伤儿童需要及时识别，快速转诊和高质量的紧急管理。我们进行了一项研究，以评估危重病或受伤儿童的护理途径，以确定可预防的失败，在careprovided.MethodsA危重病和受伤的儿童长达一年的队列研究在开普敦，南非，从第一次介绍到医疗服务，直到儿科重症监护病房（PICU）入院或急诊科死亡，使用专家小组审查的医疗记录和护理人员访谈。主要结果是专家评估的整体质量的护理;可避免的严重程度的疾病和PICU入院或死亡和识别的可修改的factors.ResultsThe研究纳入了282名儿童，252个急诊PICU入院，30例死亡。在10%的案例中，全球护理质量被评为良好，其中一半至少有一个主要的影响可修改因素。关键的可改变因素与获得护理和危重病的识别、严重程度评估、复苏不充分以及决策和转诊延迟有关。儿童从首次就诊到进入PICU的平均时间为12.3小时。185名（74%）儿童的疾病严重程度是可以避免的，17/30的儿童在进入PICU前死亡是可以避免的（56.7%）的儿童。结论这项研究提出了一种新的方法，检查整个系统的护理质量，并强调了途径的复杂性和可修改的事件，可以降低死亡率和发病率，并优化稀缺的重症护理资源的利用;以及证明护理的连续性和质量的重要性。
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.