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NHS England issues updated guidance on paediatric intensive care units

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There has been a change in the terminology used when the NHS in England is defining so-called “surge” procedures and bed capacity problems for children requiring critical care.

NHS England has just published updated guidance for managing seasonal pressures in paediatric intensive care.

“It is vital that everybody working in paediatric critical care services familiarises themselves”

Peter Wilson

The Paediatric Intensive Care Surge Standard Operating Procedure sets out instructions for managing unplanned peaks in demand for critical care beds, across the country’s 29 paediatric intensive care units (PICUs).

Every year at around this time, the numbers of very sick children requiring treatment in PICUs increases, as levels of respiratory infection rise, said NHS England.

It noted that the demand for critical care beds was “exacerbated” by wider pressures across the NHS system and social care, as “winter starts to bite”.

NHS England said the Surge procedure, originally published in 2013, had been updated and would be circulated directly to all PICUs across England.

It will be used by hospitals to determine the circumstances where rising demand for beds should be escalated and how to do this, it noted.

Meanwhile, the guideline document highlighted that surge capacity requirements were usually agreed at a regional level.

Only when referrals increase above the definition for “normal” levels and capability within the service was exhausted would escalation be required.

Under the new guidance, the levels of surge and escalation are described using OPEL definitions, while the previous version used Critcon definitions.

The escalation levels in the new version of the guidelines have been “adjusted to reflect the terminology” referenced in NHS England’s latest Operational Pressures Escalation Levels Framework.

As a result of the change, status levels previously referred to as Critcon 1,2,3 and 4 will now be called Opel 1,2,3 and 4.

Separately, paediatric intensive care services are one of the subjects of a national review of children’s critical care and specialised surgery, which is being carried out by NHS England.

Dr Peter Wilson, a paediatric intensivist and clinical co-chair of NHS England’s women and children programme of care, said: “It is vital that everybody working in paediatric critical care services familiarises themselves with the Surge procedure.

“This will enable us to respond, at a regional and national level to rising and unmanageable demand for services,” he said. “This will help us to work with services to plan effectively and ensure children have ready access to care as close to home as possible.

“The capacity and resilience of our paediatric critical care services are an important part of NHS England’s current review of services, and we will be working closely with key stakeholders to identify solutions to improve services for the future,” he added.

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