Setting up a paediatric retrieval team

Paediatric high dependency provision: a case for urgent review in the United Kingdom

The issues surrounding paediatric high dependency provision require attention. The field of adult high dependency has revealed some useful studies, which promote the benefits of designated care. These relate to improved quality of care and reduced pressure on the availability of intensive care beds. This review outlines recent initiatives made in the development of paediatric intensive care units in Britain and demonstrates how practical lessons learnt in the adult critical care sector may be used to establish appropriate Level 1 care in paediatrics. Two paediatric clinical issues are reviewed that support the need for high dependency provision, these being: paediatric respiratory management and the management of sedation withdrawal. The options available to district general hospitals, specialist hospitals, as well as lead paediatric hospitals are discussed, and include quality issues, where education, training and clinical audit are integral to structural and staffing HDU considerations.

Critical analysis of access to and availability of intensive care

In intensive care, there appears to be an ever-increasing demand for resources and it is widely recognized that there is often a shortage of vacant beds available, compounded by an inadequate level of appropriately qualified nursing staff. Either of these deficiencies may lead to delayed or even refused admission for a patient who is critically ill. This review of the literature contains examination of the access and availability of intensive care facilities within the National Health Service and discussion of the problems that arise in gaining admission to such facilities. Being refused admission to the local intensive care unit may have important implications for a critically ill patient, resulting in transfer to another hospital, perhaps many miles away, or inadequate treatment and care in a general ward. These issues are also examined and strategies for action are proposed.