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Out-of-hours paediatric care no greater risk than normal care

Children admitted to UK intensive care units in out-of-hours emergencies are at no greater risk of dying than children arriving during normal working hours, according to new research.

But the University of Leeds and the University of Leicester researchers found that death rates rise substantially in the winter.

It is the first big study into the effect of admission times on deaths in paediatric intensive care units.

The research contradicts an earlier study in 2010 which said that mortality rates for patients admitted for weekend emergency treatment were up to 10% higher than those brought in during normal working hours.

The new study’s results are expected to have a significant influence on the debate on out-of-hours NHS provision.

The Royal College of Pediatrics and Child Health warned last month that many children admitted out of hours with serious health problems are not seeing a senior paediatrician quickly.

Two months earlier Sir Bruce Keogh, medical director of NHS England, called for seven-days-a-week consultant-led care.

The new study was based on admissions to 29 paediatric intensive care units between 2006 and 2011.

It did not find any negative consequences for weekend or night-time emergency admissions.

The study did, however, find a near doubling of mortality risk for children admitted outside weekday 9-5 provision after a planned admission. This heightened risk is thought to be related to children who have undertaken long, complex surgery that brings a higher danger of mortality.

The report also found significantly higher mortality rates in the winter, even after factoring in extra health risks for children in the colder months, with a 13% rise in deaths in November, December and January.

Dr Roger Parslow, a senior lecturer in the University of Leeds’ School of Medicine, urged further research into higher winter out-of-hours admission mortality rates.

The study, which was commissioned by the Healthcare Quality Improvement Partnership and undertaken by the Paediatric Intensive Care Audit Network (PICANet), was published in the Journal of Pediatrics.

<http://www.jpeds.com/article/S0022-3476> (13)00380-6/fulltext (Journal of Pediatrics, doi:10.1016/j.jpeds.2013.03.061)

 

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