Modelling the allocation of paediatric intensive care retrieval teams in England and Wales. Issue 10 (October 2019)

• Record Type: Journal Article
• Authors: King, Madeline; Ramnarayan, Padmanabhan; Seaton, Sarah E; Pagel, Christina
• Other Names: author non-byline.; Draper Elizabeth author non-byline.; Wray Jo author non-byline.; Morris Steve author non-byline.; Davies Patrick author non-byline.; Marriage Will author non-byline.; Rajah Fatemah author non-byline.; Polke Eithne author non-byline.; Mouncey Paul author non-byline.; Pearce Anna author non-byline.; Entwistle Matthew author non-byline.; Lundy Rachel author non-byline.
• Is Part Of: Archives of disease in childhood. Volume 104:Issue 10(2019)
• Page Start: 962
• Publication Date: 2019-10
• Subjects: Intensive Care -- Mathematical Modelling -- System Configuration; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2018-316056
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Background: Following centralisation of UK paediatric intensive care units in 1997, specialist paediatric intensive care retrieval teams (PICRTs) were established to transport critically ill children from district general hospitals (DGHs). The current location and catchment area of PICRTs covering England and Wales are based on historical referral patterns. National quality standards specify that PICRTs should reach the patient bedside within 3 hours of accepting a referral. Objective: To determine what proportion of demand for PICRT services in England and Wales can be reached within 3 hours and to explore the potential coverage impact of more stringent 'time to bedside' standards. Methods: We used mathematical location–allocation methods to: (1) determine the optimal allocation of DGHs to current PICRT locations to minimise road journey time and calculated the proportion of demand reachable within 3 hours, 2 hours, 90 min, 75 min and 1 hour and (2) explore the impact of changing the number and location of PICRTs on demand coverage for the different time thresholds. Results: For current (and optimal) location of 11 PICRTs, 98% (98%) of demand is reachable within 3 hours; 86% (91%) within 2 hours; 59% (69%) within 90 min; 33% (39%) within 75 min; and 20% (20%) within 1 hour. Five hospitals were not reachable within 3 hours. For the 3-hour standard, eight optimally located PICRT locations had similar coverage as the current 11 locations. Conclusions: If new evidence supports reduction in the time to bedside standard, many more hospitals will not be adequately covered. Location–allocation optimisation is a powerful technique for supporting evidence-based service configuration.