Deterioration in all sick children in hospital, regardless of the underlying condition or diagnosis Other
Conditions
Interventions
The interventional component uses Health IT technology to improve the screening of patients to identify early signs of deterioration, including sepsis with the aim of prompting enhanced clinical care
Careflow Vitals and Connect
Comparison: Standard care
where children are monitored and h
Sponsors
University of Liverpool
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Hospital ward in-patient 2. Age 0-18 years
Exclusion criteria
Exclusion criteria: 1. Day case patients or outpatients 2. Young adults >18 years 3. Patients already in PICU
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Measured at baseline and 1 year post intervention: 1. Emergency transfers to Critical Care (PICU/HDU); number of unplanned admissions from in-patient ward, prevalence per 1,000 hospital admissions 1.1. Total bed days; total bed days or part bed calendar days in PICU or HDU used for unplanned admission from in-patient ward 1.2. Severity of illness (PIM3); unplanned admission from in-patient ward to PICU only, PIM3 taken at first contact with PICU team 1.3. Length of stay; PICU or HDU length of stay (individual and combined critical care length of stay)/days or part calendar days 2. Sepsis identification and response; screening questions all in-patients 2.1. Could this be sepsis? Number yes (denominator number of screenings), in the yes cohort stratification of risk: moderate or high, treat as sepsis confirmed by clinician, bundled management of sepsis 3. Interventions (days): 3.1. Mechanical ventilation; calendar days or part days invasively ventilated 3.2. Non-invasive ventilation; calendar days or part days non-invasive respiratory support 3.3. Inotropes; calendar days or part days of inotropes 3.4. Dialysis; calendar days or part days non-invasive respiratory support | — |
Secondary
| Measure | Time frame |
|---|---|
| Measured at baseline and 1 year post intervention: 1. Prevalence of Critical Deterioration Events per 1,000 hospital admissions (as defined by Bonafide 2012); a subsection of unplanned in-patient transfers to HDU or PICU from within the same hospital, who require organ support immediately preceding transferor within the following 12 hours 2. Cardiac arrests, respiratory arrests, any activation of resuscitation team; number of activations of the resuscitation team, stratified by mechanism 3. Mortality (all cause). Patients from study areas in-patient wards only. Deaths of patients who were never admitted to a study ward are excluded (e.g direct admissions to PICU from ED) 4. Critical care activity: total PICU and HDU admissions, the total PICU and HDU bed days or part bed days for any admission to PICU or HDU: 4.1. Severity of illness; All cause PICU admissions PIM3, at first contact with PICU team 4.2. Length of stay; All cause PICU and HDU length of stay/calendar days or part days 4.3. Internal/external refused emergency admissions; Refused request for a PICU or HDU bed as bed not available (excludes bed not clinically warranted); number of refusals within the hospital or for external transfers in 4.4. Cancellations of major elective surgery requiring an HDU or PICU bed; Surgery cancelled because a PICU or HDU bed was bed not available, number of cancelled 5. Hospital activity: total (ward) admissions, total bed days/month, median length of stay | — |
Countries
England, United Kingdom
Outcome results
None listed