Breakthrough study cuts time young patients spend in intensive care

Changing the way hospital staff respond to changes in the clinical condition of young patients could help to avoid a trip to intensive care, an Edinburgh study has revealed.

Most children admitted to hospital recover on hospital wards, however, some may become more unwell, at times quite rapidly – but training staff to react to early symptoms could save lives and improve patient outcomes, says the study’s lead Dr Ulf Theilen.

“The earlier we can spot the signs of patients becoming more unwell the better – we can take evasive action to prevent the condition getting much worse, meaning we can often avoid admission to intensive care or, if necessary, reduce the time the patients and their families spend in this stressful environment,” says Dr Theilen, from the city’s Royal Hospital for Sick Children (RHSC).

The study was carried out over a three year period and involved ward staff at the RHSC taking part in weekly team training with their colleagues from the emergency department and intensive care. This enabled them to better spot subtle changes in children’s conditions, which might indicate something more serious. Additionally, by training regularly with their colleagues who specialise in deteriorating patients, they learned how best to escalate care when more serious problems occurred.

“This was particularly helpful because it meant that, whatever the time of day, we were able to rapidly get the most experienced clinicians to the patient’s bedside and treatment was escalated while patients were still on the ward,” said Dr Theilen.

Five-year-old Natalya Anderson is one RHSC patient who has benefitted from changes instigated by the study.

Natalya’s condition deteriorated while she was an inpatient – thankfully staff on the ward had undergone this specialist training and they recognised that they needed to act quickly, explained mum Ashley Sim.

“Natalya has a low-grade glioma brain tumour and she was admitted to the children’s hospital in February this year and during the night at 1.30am she developed breathing difficulties. Staff reacted quickly, her treatment was stepped up and before the morning she was in intensive care. She spent just over a week in intensive care and made a full recovery,” said Ashley Sim.

“A few months before that, her condition had deteriorated while she was at home and she was in intensive care for much longer.”

The study showed that doctors and nurses were often able to prevent children from deteriorating further. Admissions from hospital wards to the intensive care unit reduced by over 40% and the total time patients spent on the intensive care unit reduced by more than 60%. There was also a trend towards fewer children dying in the intensive care unit.

“I can’t see why this approach should only work in paediatrics - it would make a lot of sense to test regular team training in other acute specialties and other hospitals” said Dr Theilen, who has now published the findings of the study in the international journal Resuscitation.

"Medical emergency teams exist in many hospitals. What is unusual at the RHSC is that the team receives weekly in-house training and that key staff from the wards train together with their colleagues from the Emergency Department and intensive care. Training is led by consultants and senior nurses from departments across the RHSC, ensuring training is relevant for every area."​