paediatric intensive care surge standard operating procedure
TRANSCRIPT
NHS England and NHS Improvement
Paediatric Intensive Care Surge Standard Operating Procedure
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Contents
Introduction .................................................................................... 2
Context .......................................................................................... 2
Roles and Responsibilities ............................................................. 3
Surge and Escalation Management Arrangements ....................... 4
Description of Escalation PIC OPEL Levels ................................... 5
Data Sources ................................................................................. 5
Engagement .................................................................................. 6
Equality and Health Inequalities Analysis ...................................... 6
Glossary ......................................................................................... 7
Appendices .................................................................................... 8
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Introduction
This document provides a framework for the Paediatric Intensive Care (PIC)
community responses to manage escalating and unplanned peaks in demand for
paediatric intensive care beds.
In the context of this Standard Operating Procedure (SOP), the term surge is used to
describe pressure on the whole paediatric intensive care system which may require
regional or national support.
It is intended for use by all NHS acute hospital providers with paediatric intensive care
facilities on site but recognises that whole system solutions will be required to ensure
timely access to intensive care for the sickest children.
Context
The paediatric critical care pathway includes level one, two and three care. Levels 1
and 2 maps to high dependency care and level 3 relates to paediatric intensive care.
In the Paediatric Critical Care (PCC) Healthcare Resource Group (HRG) classification
levels 1, 2 and 3 paediatric critical care are also known as follows:
• Level 1 (L1) critical care: Basic Critical Care
• Level 2 (L2) critical care: Intermediate Critical Care
• Level 3 (L3) critical care: Advanced Critical Care
The whole pathway of care includes specialist paediatric transport services. This
document focusses on capacity and flow related to level 3; in simple terms this refers
to children requiring paediatric intensive care.
Services are organised such that the most acutely unwell children or, those requiring
intensive care after surgery are cared for in an intensive care unit. There are 22 level
3 units in England - a list of these is attached at Appendix 1.
NHS England operates with 7 new regional teams. In some areas, there will only be
one paediatric intensive care unit; so, for the purpose of managing PIC Surge, OPEL
2 will be declared based on those units within the previous four regional geographies,
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to be known as PIC Surge Regions. These are referenced and described in detail in
Appendix 1 and in the Action cards.
The contacts for the regional specialised commissioning teams that will be responding
to surge in hours as well as the NHS England on call teams are attached at Appendix
2.
This document should be read with reference to individual provider surge response
plans.
Roles and Responsibilities
Individual Trusts are responsible for preparing for PIC surge. This includes
documented PIC surge plans e.g. cancellation criteria for elective surgery, movement
of staff and plans on increasing capacity when there are known peaks in demand such
as Winter.
At all times, the clinical teams remain responsible for the management and
decision making of patient care. Providers MUST work together and in collaboration
with Paediatric Critical Care Operational Delivery Networks (where established) to
ensure that optimal care is delivered across the pathway. Consultant to Consultant
discussion regarding clinical decision making and patient flow between units has been
identified as imperative for management of surge. During surge periods it is essential
that clinical representation on conference calls is achieved. See the Action cards at
Appendix 3.
The regional specialised commissioning teams are responsible for working with
Providers and where relevant local Clinical Commissioning Groups (for acute
paediatric care) to plan bed capacity; this includes planning for known surges which
occur during winter.
Regional specialised commissioning teams must have processes in place to
understand and assess capacity, to make decisions about PIC OPEL levels and
respond to these accordingly. They must inform the seven respective U&EC
Operations teams where challenges occur that might impact performance and/or
patient safety.
NHS England and NHS Improvement has a Directorate for Urgent & Emergency
Care operational delivery, transformation and strategic direction. Operational Teams
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have responsibility for U&EC in each of the seven regions as well as a national function
to co-ordinate assurance and support.
Where surge is being encountered related to PIC which is liable to impact on U&EC
performance and/or patient safety the appropriate regional U&EC Operations Lead
must be informed as part of the escalation process. See Appendix 2.
Where surge occurs out-of-hours the national U&EC Operations On-Call Director
should be informed.
The Regional EPRR team will consider information regarding capacity issues in PIC
to assess the impact on concurrent major incident responsibilities and where
necessary, escalate the perceived regional impact to the National EPRR team.
The National EPRR team will consider information regarding capacity issues in PIC
to assess the impact on concurrent major incident responsibilities.
The Action Cards at Appendix 3 set out the roles and responsibilities to be undertaken
during periods of surge for PIC providers, regional specialised commissioning teams
and NHS England.
Surge and Escalation Management Arrangements
Bed and specialist paediatric transport services capacity requirements are agreed and
managed at a regional level. Only when capability within the service is exhausted will
escalation be required.
The levels of surge and escalation are described using the PIC OPEL (Paediatric
Intensive Care Operational Pressures Escalation Levels) (previously Critcon)
definitions as shown below. For each PIC OPEL level there is an associated action
card to be followed. See Appendix 3.
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Description of Escalation PIC OPEL Levels
The PIC OPEL levels describe capacity constraints within PIC Surge Regions which
may require local and potentially national escalation processes.
A description of OPEL levels used more broadly across the NHS can be found here:
https://www.england.nhs.uk/wp-content/uploads/2019/02/operational-pressures-
escalation-levels-framework-v2.pdf
Data Sources
Data held on the NHS Pathway Directory of Service (PathwayDos) Capacity
Management System CMS PIC bed management page MUST be updated by
individual services twice daily at 10.00 and 20.00 as a minimum. Data can be
entered by EBS (Emergency Bed Service or the Specialist Paediatric Transport team
after discussion with a senior nurse or medic on duty), or by the individual PIC unit.
Paediatric intensive care units must ensure that they have timely access to PIC CMS.
The data fields have been updated to include RAG status by unit and capacity to admit
>6hours.
Definition Status
NORMAL (GREEN)
• The PIC service is able to meet all capacity requirements without impacting on other services or organisations.
Business as Usual
LOW SURGE (AMBER)
• The PIC service’s capacity and or skill mix within a PIC Surge Region is becoming limited but PIC units are able to receive patients and maintain optimal care.
PIC OPEL One
MEDIUM SURGE (RED)
• All PIC services within a single or multiple PIC Surge Regions are operating at maximum capacity AND are unable to accept new referrals within 6 hours.
PIC OPEL Two
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Trusts need to also ensure that they record PIC capacity data for bed
management/operational meetings. They must record the number of available PIC
level 3 beds and identify if the service is unable to accept a patient for >6 hours. This
data will be updated at the Trust bed meetings. These can be referred to as GREEN,
AMBER or RED.
A capacity monitoring report template is used for collecting more detailed data to
inform surge discussions. See Appendix 4. NB: Doubling of level 3 patients has been
added to assess the severity of capacity pressures. It is important to note that this is
purely for the purpose of assessing winter surge and is not a general expectation.
All acute Trusts provide a Daily Winter SitRep return that provides a profile of capacity
to NHS Improvement through “Tableau”. From a paediatric critical care perspective
this will only include level 3 paediatric intensive care beds. Monthly SitRep data will
be collected and published by NHS England. The guidance for the monthly (MSitReps)
is available here:
https://www.england.nhs.uk/statistics/statistical-work-areas/critical-care-capacity/
The latest data and Statistical Press Notice will be published here:
Statistics » Critical Care Bed Capacity and Urgent Operations Cancelled 2019-20
Data
Engagement
This document has been reviewed by the Paediatric Intensive Care Clinical
Reference Group and the Women and Children’s Programme of Care Board.
Equality and Health Inequalities Analysis
This procedural document forms part of NHS England’s commitment to create a
positive culture of respect for all individuals including staff, patients, their families and
carers as well as community partners. The intention is to identify, remove or minimise
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discriminatory practice in the areas of race, disability, gender, sexual orientation, age
and ‘religion, belief, faith and spirituality’ as well as to promote positive practice and
value the diversity of all individuals and communities.
Every corporate procedural document must include an assessment of the impact it will
have on inequalities and on addressing health inequalities and the following template
must be completed. Further advice can be obtained from the Equality & Health
Inequalities Team.
Glossary
CCG Clinical Commissioning Group
CMS Capacity Management System
DGH District general Hospital
EBS Emergency Bed Service
ECMO Extra Corporeal Membrane Oxygenation
EPRR Emergency Preparedness, Resilience and Response
HDU High Dependency Unit
HRG Healthcare Resource Group
ODN Operational Delivery Network
OOH Out of hours
OPEL Operational Pressures Escalation Level
PCC Paediatric Critical Care - levels 1, 2 and 3
PIC Paediatric Intensive Care - level 3
PICU Paediatric Intensive Care Unit
POC Programme of Care
RAG Red, Amber, Green
SitRep Situation Report
SOP Standard Operating Procedure
U&EC Urgent and Emergency Care (also may be known as Elective and Emergency Care)
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Appendices
Appendix 1 - Paediatric Intensive Care Units and PIC Surge Regions
NHS England
RegionsNorth West East of England South East South West
Operational
Delivery Networks
North East &
Cumbria
Yorkshire & Humber North West East Midlands West Midlands East of England North Thames South Thames Thames Valley &
Wessex
South West
The Newcastle Upon
Tyne Hospitals NHS
Foundation Trust
(Great North
Children’s Hospital &
Freeman Hospital)
Sheffield Children's
Hospital
Alder Hey Children's
Hospital
University Hospitals of
Leicester (Leicester
Glenfield Hospital &
Leicester Royal
Infirmary)
Birmingham Children's
Hospital
Addenbrooke's
Hospital (Cambridge
University Hospitals)
The Royal London
Hospital (Barts Health
NHS Trust)
St. George’s
Healthcare NHS Trust
Southampton
Children’s Hospital
Royal Brompton
Hospital
King’s College
Hospital NHS
Foundation Trust
(University Hospital
Lewisham)
St Mary's Hospital
(Imperial College
Healthcare NHS
Trust)
Great Ormond Street
Hospital for Children
NHS Trust
SORT - Southampton and Oxford
NORTH PIC SURGE REGIONS MIDLANDS & EAST PIC SURGE REGIONS LONDON PIC SURGE REGION SOUTH PIC SURGE REGION
North East & Yorkshire Midlands London
Royal Stoke
University Hospital
(University Hospitals
of North Midlands
NHS Trust)
Evelina London
Children’s Hospital
(Guy's and St
Thomas' NHS
Foundation Trust)
The John Radcliffe
Hospital (Oxford
University Hospitals)
Bristol Royal Hospital
for Children
* The paediatric emergency transport teams work across the regional boundaries described here
Level 3 & 2
Leeds Teaching
Hospitals (Leeds
General Infirmary)
Royal Manchester
Children's Hospital
Nottingham Children’s
Hospital
COMET - Retrieval Service
KIDS - Birmingham Retrieval ServiceTransport Teams *
EMBRACE - Yorkshire & Humber Infant & Childrens Transport
Service
NECTAR - North East Childrens Transport and Retrieval Service
NEWTS - North West & North Wales Transport Team
STRS - South Thames Retrieval Service
CATS - Childrens Acute Transport Service
WATch - Wales and West Acute Transport
for Children
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Appendix 2 – Regional & National Contact Details In and Out of Hours In the event that a national escalation call is required out of hours this can be organised by escalating to the NHS England & NHS
Improvement National U&EC Director or EPRR Second On Call: Contact Number 0333 200 5022 requesting NHS 05.
These requests will usually be initiated by a Regional Director
Contact details for national escalation & U&EC (Winter Rooms)
Winter Rooms U&EC In Hours Contact Ops Lead Urgent In hours contact
Out of hours
National Winter Room
Chris Corkett/Marion
Collict
02079 725 192
England.uec-
North [email protected] Tom Quartley 07342 068252 National on-call rota details will
be issued each week once
winter surge cover period
begins
London england.london-
Diana Lacey 07876 859947
Midlands [email protected] Charlotte Aston 07855 350 304
East of England england.er-
Phil Storr 01480 221 186
South East [email protected] Bernard Quinn 07747 794 054
South West [email protected] Kevin Johnson 07730 376 501
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North PIC Surge Region Contacts
Hub Role Name Telephone Email
North East and Cumbria
Assistant Director Penny Gray 07876 851860 [email protected]
Service specialist Julie Bloomfield 07730379898 [email protected]
Business Support 0113 825 1602
North West (including
South Cumbria)
Director of specialised commissioning
Andrew Bibby 07909 000281 0113 825 2600
Service specialist Abby Peters 07568431607 [email protected]
Business support 0113 825 2736
Yorkshire and Humber
Assistant Director Matthew Groom 07860177983 [email protected]
Senior service specialist Sarah Halstead 07900 715105 [email protected]
Business support 0113 825 3391
Service specialist Emma Green 07876869440 [email protected]
Region POC Manager Sharon Hodgson 07860178006 [email protected]
Regional Head of EPRR
Paul Dickens
0113 825 0884 | Mobile: 07824 124 394
Regional On Call Duty Officer: 0191 4302 453
North Regional Spec comm contact out of hours
working
Ask for regional specialised
commissioning manager
0191 4302453 (back up
– 0191 4302498)
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South Region PIC Surge Contacts
Hub Days Role Name Telephone Email
First point of contact South East and South West Region In Hours
Mon-Fri Network Manager Wessex Thames valley PCC ODN
Nat Hughes 07464 492624
South East – Wessex & Thames Valley
Mon – Fri Transformation Delivery Manager Sian Summers 07721 231718 [email protected]
Mon – Fri Business support 07730 380199
South West Mon – Fri Transformation Delivery Lead Charlotte Ives 07710 152297 [email protected]
Mon – Fri Business support
07730 389776
South Region PIC OPEL 2
Mon – Fri South West Regional Medical Director Peter Wilson 07899 996248 [email protected]
Regional head of EPRR Mon - Fri Regional Head of Emergency Preparedness, Resilience and Response
Andy Wapling 0113 825 4745 07747 781066
Joint South East and South West Out of Hours and Bank Holidays
Joint South East and South West Spec Comm Regional Director on call
0300 033 9972
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Midlands & East PIC Surge Region Contacts
HUB PCC Surge Lead Telephone Email
EAST MIDLANDS When absent: Administrator:
Jude Bowler Dom Tolley Di Panter
0773 0371 063 07584 334298 0113 8249143
[email protected] [email protected] [email protected]
WEST MIDLANDS When absent: Administrator:
Alice Nason Sue Eaton Amy Ellis
07733 327613 0756 843 1569 07702 410204
[email protected] [email protected] [email protected]
EAST OF ENGLAND When absent: Administrator:
Richard McDonald Alex Ridgeon Fi Blower
07920 252110 07860 178937 07540 883564
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Midland and East (Surge Region Contact) Daniel Eve, Programme of Care Manager: [email protected] 07920252193
Out of Hours East of England 2nd on call director pager – 07623 515955 Midlands on call pagers – 07623 515940 (Arden, Hereford & Worcester/Birmingham, Solihull & Black Country) and 07623 515946 Derbyshire, Nottinghamshire, Staffordshire, Shropshire, Leicester, Leicestershire, Rutland, Northamptonshire, Lincolnshire
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London Region PIC Surge Contacts
Role Name Telephone
London
Programme of Care Manager &
National Lead Commissioner for PIC
Rachel Lundy
07900712998 [email protected]
London
Senior Quality &
Transformation Manager
Konstantinos Tsormpatzidis
07876 852130
London
Programme Director, Cardiac
& Paediatrics
Hazel Fisher
07900 713052
London
Senior Clinical Networks
Manager
Kathy Brennan
07568431665
London
Regional Medical Director
Dr Simon Barton
07730 382108
London (Region) Out of Hours and Bank Holidays – 0844 8222888 Leave a message for NHS 01 who will contact the regional on call manager
Appendix 3 – OPEL Action Cards
PIC Level – Normal
The PIC service is able to meet all capacity requirements without impacting on other
services or organisations.
Paediatric Critical Care Service
1. 2.
Will update the PIC CMS system when patients are admitted and / or discharged or at least twice daily at 10am and 8pm during normal service delivery. (Unit, EBS, ODN or specialist paediatric transport team) Each service will record the escalation level GREEN in the “Service Notes” section of the system. PIC CMS produces an automated RAG status based on known bed numbers and beds in use. Units must indicate their own RAG status in a parallel column which may be different to the automated RAG status if the PIC Unit determines, based on staffing or anticipated patient flow, that their capacity is different.
3. 4.
The PIC service and Trust bed managers will meet routinely (frequency as per organisation’s policy) to discuss the management of bed capacity, capability (skill mix of staff). Trusts should review the PIC CMS system to consider regional bed availability to inform their own planning decisions. PIC capacity must be consistently reviewed as part of wider Trust capacity at an operational level including all Trust central bed meetings. Trusts should report PIC (level 3) bed availability.
NHS England Regional Specialised Commissioning Teams
5. 6.
Will regularly monitor bed capacity for the PIC units within their region using PIC CMS and/or specialist paediatric transport team reports as per local agreement Regional monitoring will be in place from 6/11/2019 to 26/02/20. A weekly capacity monitoring report using template (Appendix 4) will be submitted to the National Lead Commissioner for PIC every Wednesday by 1pm
NHS England On Call
7. No action required – routine monitoring out of hours.
PIC OPEL 1 The PIC service’s capacity and / or skill mix within one PIC Surge Region is becoming
limited but it is able to receive patients and maintain optimum care.
Paediatric Critical Care Service
1.
Trusts will update PIC CMS: - PIC (level 3) bed availability. The system will identify AMBER status at greater
than 85% capacity - identify if the unit is unable to admit for > 6 hours - to declare PIC unit RAG status.
NB: It is possible for an individual unit to identify RED PIC CMS status (no beds available for >6 hours) but for the PIC Surge Region to have capacity as a whole and therefore operating at PIC OPEL 1.
2. Inform the specialist paediatric transport Service by telephone of the PIC CMS RAG status of the PIC unit.
3.
The PIC service and Trust bed managers must meet (frequency as per organisation’s policy) to discuss management of capacity, elective admissions and workforce pressures. PIC capacity must be reviewed as part of the wider Trust capacity at an operational level including all Trust central bed meetings. This will trigger Trust escalation procedures to ensure that appropriate action is taken (e.g. maximise repatriations and ward discharges to general paediatric or neonatal care. Trust must review elective admissions for the next 24 hour period and consider the use of adult critical care beds.
NHS England Regional Specialised Commissioning Teams
4. 5.
Will work with the Paediatric Critical Care Operational Delivery Networks to regularly monitor bed capacity in their local PIC units using PIC CMS and/or specialist paediatric transport team reports as per local agreement Regional monitoring will be in place from 06/11/2019 to 26/02/20, a weekly capacity monitoring report using template (Appendix 4) will be submitted to the National Lead Commissioner for PIC every Wednesday by 1pm. Each region to maintain local contact information in order to send and receive capacity information.
NHS England On Call
6. No action required – routine monitoring out of hours.
PIC OPEL 2
All PIC services within a single or multiple PIC Surge Regions are operating at maximum capacity AND are unable to accept new referrals within 6 hours.
Paediatric Critical Care Services
1. Units to immediately amend the PIC CMS to RED status including statement indicating unable to admit >6 hours. Immediately inform local specialist paediatric transport Team.
2. Maximise repatriations and ward discharges to general paediatric or neonatal care, this should include all children who are delayed for >4 hours
3. Trust Chief Operating Officer (COO) & Clinical Director to review paediatric elective surgery requiring PIC level 3 against all current unplanned demand.
4. Consider cancellation of study leave/annual leave for PIC trained medical, nursing and key support staff.
5. Consider skill mix and resource allocation e.g. doubling patients post risk assessment
6. Review utilisation of adult intensive care for any age / clinically appropriate young people.
7.
Trust Operational meetings to be informed that the PIC unit has reached capacity and is unable to admit within 6 hours AND trigger local escalation procedures to ensure appropriate action is taken. Ensure PIC Unit has informed the local specialist paediatric transport team and Operational Delivery Network (ODN) where present (see Regional specific plans.)
8.
The specialist paediatric transport Team or ODN to escalate in hours to NHS England’s Regional Specialised Commissioning Team between the hours of 09:00 – 17:00 to flag that services are at maximum capacity and there is a risk that regional capacity may have been or will be reached – therefore potentially at PIC OPEL 2. If maximum capacity is reached out of hours (OOH) between 17:00 - 09:00 specialist paediatric transport Team to telephone the Regional Specialised or On Call Manager shown in Appendix 2.
NHS England Regional Specialised Commissioning Teams
9.
The initiating PIC Surge Region will collate the regional capacity monitoring report at Appendix 4 to assure that it accurately reflects the position in each Provider; this will facilitate a decision by the Regional Commissioning Team about the OPEL status.
10.
Having collated information in Appendix 4 the initiating region will:
• Make a decision about the PIC Surge Regional OPEL status
• Notify the local regional U&EC team (winter room/s) of their OPEL level sharing information about any delayed discharges and whether elective surgery is proceeding at Trust level.
• If OPEL 2 is confirmed across the PIC Surge Region, initiate a request to the other 3 PIC Surge Regions by email with a follow-up telephone call for a regional capacity monitoring report to be provided Appendix 4 – this should be submitted to the initiating PIC Surge Region as soon as is possible.
(NB some regions/hubs update CMS every 2 to 3 hours and will have up to date reports regardless).
11.
The initiating PIC Surge Region will review the regional capacity monitoring reports provided. If it is indicated that the surge is likely to have a material impact on patient safety or U&EC performance the relevant regional U&EC operations lead must be informed if the surge is in-hours. Where a PIC Surge Region encompasses two UEC operational teams, both must be notified. Where the surge occurs out-of-hours the National U&EC on-call Director must be informed by the regional on-call manager/s.
12.
If there is some capacity available in two out of four PIC Surge Regions in hours, or three out of four PIC Surge regions out of hours, the initiating region will work with local PIC services and where relevant, U&EC teams, to determine if this is sufficient to contain regional demand.
13.
In hours (09:00-17:00) if three or four PIC Surge Regions are at PIC OPEL 2 with no capacity the initiating regional representatives or Medical Director will convene a national conference call to consider and agree any further actions required to mitigate pressure at this stage. Call participants will be as per Table A and a draft agenda is attached at Appendix 6. Out of hours (17:00-09:00) if all four PIC Surge Regions are at PIC OPEL 2 with no capacity, the initiating region’s on call manager/s will convene a national conference call with members as outlined in Table A, using the agenda in Appendix 6.
Table A
In Hours 3 or 4 out of 4 PIC Surge Regions
Out of Hours 4 out of 4 PIC Surge Regions
Chair: Initiating PIC Surge Region Medical Director/s
Chair: Initiating PIC Surge Region Directors / On-call Manager/s
Regional Medical Directors x 7 (the
South West Region Medical Director will provide clinical support as required)
Regional Directors / On Call Managers x 7
Other nominated regional representative
Trust Directors On-Call
Consultant On-Call for each PIC and
specialist paediatric transport services and ODN lead or manager where
available
Regional U&EC/ EEC Director On-Call and Regional EPRR Leads (if
appropriate)
Consultant On-Call for each PIC and specialist paediatric transport services
Regional U&EC/ EEC Director On-Call and Regional EPRR Leads (if appropriate)
who can be contacted on: 0333 200 5022 requesting NHS 05
It is the Chair’s responsibility to disseminate agreed actions.
APPENDIX 4 – Capacity Monitoring Report
Date: Week summary: Level 3 beds actual total= L3 Commissioned beds = L2 Commissioned beds =
PIC Unit
Overall service capacity / bed availability. Doubling L3 pts
Delayed Discharges >24 hours
Elective Surgery Proceeding? (please provide any useful background information for any cancelled surgical procedures)
Number of cancelled electives this week
Known issues & mitigations for the week ahead?
PIC Unit
Overall service capacity / bed availability. Doubling L3 pts
Delayed Discharges > 24 hours
Elective Surgery Proceeding? (please provide any useful background information for any cancelled surgical procedures)
Number of cancelled electives this week
Known issues & mitigations for the week ahead?
PIC Unit
Overall service capacity / bed availability. Doubling L3 pts
Delayed Discharges > 24 hours
Elective Surgery Proceeding? (please provide any useful background information for any cancelled surgical procedures)
Number of cancelled electives this week
Known issues & mitigations for the week ahead?
PIC Unit
Overall service capacity / bed availability. Doubling L3 pts
Delayed Discharges >24 hours
Elective Surgery Proceeding? (please provide any useful background information for any cancelled surgical procedures)
Number of cancelled electives this week
Known issues & mitigations for the week ahead?
PIC Unit
Overall service capacity / bed availability. Doubling L3 pts
Delayed Discharges >24 hours
Elective Surgery Proceeding? (please provide any useful
Number of cancelled electives this week
background information for any cancelled surgical procedures)
Known issues & mitigations for the week ahead?
PIC Unit Overall service capacity / bed availability Doubling L3 pts
Delayed Discharges >24 hours
Elective Surgery Proceeding? (please provide any useful background information for any cancelled surgical procedures)
Number of cancelled electives this week
Known issues & mitigations for the week ahead?
PIC Unit
Overall service capacity / bed availability. Doubling L3 pts
Delayed Discharges >24 hours
Elective Surgery Proceeding? (please provide any useful background information for any cancelled surgical procedures)
Number of cancelled electives this week
Known issues & mitigations for the week ahead?
Transport Team:
Overall service capacity
No: Transfers meeting review criteria in preceding week *
Known issues & mitigations for the week ahead?
Children waiting >6hours Required at OPEL 2
Transport Team:
Overall service capacity
No: Transfers meeting review criteria in preceding week *
Known issues & mitigations for the week ahead?
Children waiting >6hours Required at OPEL 2
Transport Team
Overall service capacity / bed availability
No: Transfers meeting review criteria in preceding week *
Known issues & mitigations for the week ahead?
Children waiting >6hours Required at OPEL 2
*Transfers which meet review criteria are typically classified as:
• Where a child is diverted away from nearest PICU for non-clinical
reason.
• Where time to retrieval team arriving on site increased (over
expected time to nearest unit) by more than 1 hour. Travel time to
receiving unit increased (over expected time to nearest unit) by
more than 50% or 1 hour, whichever is shorter.
Information Collated by:
Name:
Title:
Date & Time:
Dear COO Name
Paediatric Intensive Care Delayed Discharge
NHS England has been notified today of a delay in the discharge of a medically fit child from the Paediatric Intensive Care Unit at (PIC unit).
I note that the discharge of this child, aged X has been delayed due to (insert reason) and as a consequence capacity to admit a critically unwell or unstable child is now compromised. The intensive care network is currently operating at OPEL OPEL Level X (insert level) as described in the attached surge standard operating procedure.
Whilst acknowledging that there will of course be periods of unprecedented demand on acute and critical care beds, we would ask you to liaise with the paediatric clinical team to expedite the discharge of this child in line with the inter hospital transfer guidelines referenced in the NHS England contract. Standard 15 requires a repatriation to occur within 24 hours of the notification to the receiving hospital’s bed management team.
Please can you contact (enter name of regional lead) to notify them of the action taken in response to this letter and confirm the date that the Trust is able to accept the transfer. Thank you for your assistance in this matter. Yours sincerely Name Associate Director X Regional Hub
Appendix 5 Delayed Discharge Letter Template
Address 1 Address 2 Address 3 Address 4 Address 5 Date
Appendix 6
NHS England Paediatric Intensive Care Teleconference Dial in Details: 0800 917 1950 Participant code: 44744236#
Chair code: 53725174# Agenda
1. Welcome and Introductions (Name, role and organisation) 2. Notes from last teleconference and review of actions (if applicable)
3. PIC Surge Region updates (using Appendix 4 Paediatric Intensive Care Surge
Standard Operating Procedure)
• North
• Midlands and East
• South
• London
4. Likely duration of current surge 5. Open discussion - Additional actions to be considered to reduce short term pressure:
Issues, risks and possible mitigations. Issues for discussion might include:
• Doubling patients, adjusting nurse to patient ratios
• Patients with single organ failure who are greater than 5 years can be treated in some adult intensive care units
• Cancelling all non-essential and non-urgent surgery Are there patients who could be repatriated to their local hospital to complete inpatient care? Medical Directors of Trusts confirming that all patients in PICU are appropriate
• Consider whether there are children which could be moved and risk assess these
• Communications to surge hubs and all DGH to expedite repatriation
• Consider other areas to ventilate children safely
• Patient Selection / Risk Assessment to consider the availability and appropriateness of NHS HDU capacity
• Private PICU Capacity (Harley Street), Capacity beyond England in Wales, Ireland or Scotland.
• Impact on the critical care system
• Potential recourse to whole system responses required in light of respective major incident plans
6. Overall impact on paediatric critical care system and identify causes where possible 7. Media/Communications Update 8. Review of agreed actions to be undertaken and deadlines for completion
9. Date and time of next call