Admissions to children’s critical care units is 14 per cent higher than pre-pandemic levels, with occupancy rates consistently exceeding recommended levels, a new report has found.
Occupancy levels at the Republic’s two paediatric critical care units (PCCUs) in Dublin often exceed 100 per cent during the winter months, the report by the National Office of Clinical Audit finds. The recommended bed occupancy rate is 85 per cent, which CHI at Crumlin exceeded each year, while CHI at Temple Street exceeded in 2019 and again in 2022. In some months during the winter these hospitals were around 115 per cent occupancy.
On Monday the office published the Irish Paediatric Critical Care Audit National Report 2021-2022. It contained a detailed analysis of these admissions, highlighting an increasing majority were secondary to seasonal viruses and respiratory syncytial virus (RSV) pathogen.
A total 30 per cent of all the children admitted to the paediatric critical care unit at Crumlin in 2022 were due to respiratory conditions, an increase from 18 per cent in 2020.
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Some 39 per cent of all admissions to the paediatric critical care unit in Temple Street in 2022 were for respiratory issues, up from 24 per cent in 2020
The development of new vaccines for RSV could radically alter the annual surge of admissions to both children’s hospitals and paediatric critical care units, and in doing so influence its effect on bed occupancy and elective surgical deferrals, the report said.
Quality indicators of unit strain, such as bed occupancy and out-of-hours discharges, showed an increase in 2021 and 2022.
In terms of admissions at Temple Street paediatric critical care unit in 2022, admissions was 542 children, an increase of 34 per cent when compared to 2018.
Crumlin had the third highest number of paediatric critical care unit admissions of all units in the UK and Ireland in 2021 with 1,098 admissions and 2022 with 1,092 admissions
A significant number of admissions to paediatric critical care units in Ireland were very young babies, known as neonates. Neonates are babies that are defined as corrected age at admission of less than 29 days old. Corrected age takes a baby’s actual due date and the gestational week in which they were born into account
The median length of stay was highest for infants aged under one year. Infants aged under three months spent the longest time in both units – 5.14 days at Crumlin and 3.57 days at Temple Street
The number of qualified nurses per bed remains below the recommended standard at Temple Street for each of the five years examined.
With the new national children’s hospital (NCH) due to open in 2025 with an additional 10 paediatric critical care unit beds there is a need to plan for adequate resourcing to maintain an average bed occupancy of 85 per cent and allow for acute surges in demand, staff sick leave and maternity leave, the audit concludes.
Associate professor Martina Healy, clinical lead of the Irish Paediatric Critical Care Audit, emphasised the critical need for strategic planning and resources.
“The data clearly indicate an urgent need for a detailed workforce plan to facilitate the opening of the NCH PCCU,” she said. “This plan must address the recruitment and retention of paediatric critical care consultants, trainees, and nursing staff to ensure the unit can operate at optimal capacity. Our findings show that adequately staffed and skilled PCCUs deliver significantly better outcomes for patients.”
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