Outcomes from paediatric intensive care remain good despite poor staffing ratios

Published: 03 Nov 2015

Mortality rates in children’s intensive care units across the country remain very low, despite only 15% of them meeting recommended nurse staffing levels, today’s Paediatric Intensive Care Audit report finds.

Of 19,760 admissions of children to paediatric intensive care units (PICUs) in 2014, less than 4% died after being admitted, according to the latest report from the Paediatric Intensive Care Audit Network (PICANet – a combined project from the Universities of Leeds and Leicester). The audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme.

The mortality rate remains low despite only five out of 34 PICUs meeting the current nurse staffing levels as set out in Paediatric Intensive Care Society (PICS) standards and a high percentage of agency and bank nursing staff working in PICUs in some regions.

Professor Liz Draper, from the College of Medicine, Biological Sciences and Psychology at the University of Leicester, said: “Paediatric intensive care units continue to have difficulty achieving the PICS nursing standards and a more detailed analysis of this problem has shown a particular issue for NHS PICUs in London, where the use of agency and bank nursing staff was as high as 25% from our snapshot survey at midnight on a Sunday.

“It is difficult to achieve continuity of care and the use of a designated nurse when staffing is so stretched and the complexity of care required by the children admitted to intensive care continues to rise. Problems with the recruitment and retention of nursing staff in this stressful environment are growing and innovative solutions are required to maintain a high-quality workforce, such as self-rostering and more flexible working for staff with families and other dependants.”

Although there has been no significant increase in the number of children admitted to PICUs over the last three years, children are spending longer in them. Beds were occupied for 131,268 days in 2014 – an increase of 2,748 bed days compared with 2013.

Dr Roger Parslow, of the School of Medicine at the University of Leeds, added: “It is gratifying to know that despite continuing problems with staffing we have not observed a measurable reduction in the quality of paediatric intensive care delivered by the 34 PICUs covered in the report.

“Continued pressure on the service caused by more admissions, longer stays and inadequate staffing levels may, at some stage, result in changes to the quality of service delivered. PICANet will closely monitor outcomes and processes in UK and Ireland PICUs over the next 12 months to detect any such change.”

The 12th annual report from PICANet, on activity and outcomes in paediatric intensive care services in the UK and Ireland, includes a series of special articles on the uses of PICANet data for driving quality improvement through research and clinical trials as well as providing information for commissioning and service development.