DEPICT (Differences in access to Emergency Paediatric Intensive Care and care during Transport) is a research study funded by the National Institute for Health Research (Health Services and Delivery Research Programme, ref: 15/136/45). The Chief Investigator for the study is Dr Padmanabhan Ramnarayan and the Study Sponsor is Great Ormond Street Hospital NHS Foundation Trust.
Children and young people who are very ill often need to be transferred to a specialist ward called a paediatric intensive care unit or a ‘PICU’. The specialist teams that perform this transfer are called transport teams.
Across the country we know there are differences in how quickly transport teams can reach sick children and how the transport is performed. This may be because the PICU is very far away from the hospital from which the child needed to be transported from, or may be because of how busy transport teams are.
The main aim of the DEPICT study is to understand whether these differences influence how children recover and how children and their families experience being transported to a PICU. We hope the results from our study will help to improve how NHS transport services are organised in the future and to better support families who use the transport services.
Children's intensive care is a high-cost and specialised service, with fewer than 30 paediatric intensive care units (PICUs) in the UK. This means that a child taken to their nearest hospital with critical illness or injury will usually need to be transferred to a PICU for further treatment. Each year, 6000 children require emergency transfer from a local hospital to a PICU, on average 20-30 miles away. These children tend to be very sick.
Transports of sick children to PICUs are usually done by specialist transport teams, which are mobile intensive care teams who take specialist expertise to the child and safely transport them to a PICU. In previous research, we showed that transport teams improve the survival of critically ill children. However, how quickly transport teams are able to reach sick children, and how they are organised and deliver clinical care varies across the UK. There has been little research into these differences and how they might influence outcomes and experiences for sick children and their families. In the absence of hard evidence, current national standards are based on the opinion of clinical experts. In short, we do not know if national variation in how PICRT services are organised and delivered matters, or whether current standards help achieve the best outcomes for patients.
We want to do research to better understand whether and how existing differences in access to paediatric intensive care and care provided by transport teams affect clinical outcomes and experiences for transported sick children and their families.
We plan to analyse data collected by two national audits (PICANet: www.picanet.org.uk and CMP: www.icnarc.org) to examine various aspects such as how long it takes a transport team to reach the patient, how long it takes the child to reach the PICU, the seniority of clinicians performing the transport, medical procedures performed by the transport team and any critical incidents that occur during transport. We will investigate whether any of these factors influence how likely a child is to survive. We will also study other clinical outcomes such as how long the child stays in PICU and in hospital, procedures performed, and hospital attendances after discharge from PICU.
As well as clinical outcomes, we will collect and analyse information about the experiences of sick children by asking families to complete a questionnaire regarding their transport experience and by interviewing the families involved. We will collect staff experiences of PICU transport by interviewing clinicians from PICUs, transport teams, and local hospitals. Alongside this work, we will look at the costs of different ways of delivering transport services for sick children and which may represent best value for money, and use mathematical techniques to study if and how alternate models of service delivery can improve clinical outcomes in a cost effective manner.
For more information about the study, including details of how we propose to answer the main research questions, read through our study protocol and related documents.