Introduction The ideal model is for children on Long Term Ventilation (LTV) is to be cared for in a non-critical care environment wherever possible (Paediatric Critical Care GIRFT 2022). The model for paediatric LTV admissions in CUH is within HDU. Increased HDU bed pressures post Covid-19 pandemic led to a pathway being created for stable patients on non-invasive respiratory support to have sleep studies on a general paediatric ward (figure 1). The success measures were timely and good quality studies (minimum of 4 hours of TST, respiratory effort band data and TcCO2), positive patient/carer and staff feedback.
Methods In this retrospective analysis, time from referral to completion of sleep study, sleep study quality and parent and staff feedback was analysed.
Results The average wait time from referral to study was 136.25 days +/- 125.7 SD. The total number of elective LTV sleep studies (figure 2) performed on C3 was 36 with a success rate of 94.5%. Two studies were unsuccessful due non-technical problems (acute patient deterioration and TST <4h). In comparison, our sleep unit had a 2% failure rate over the same 12-month period on non-ventilated patients.
20 patient/parental feedback questionnaires were gathered ranking the mean overall experience as 9/10 (+/-1.15) with 9.1/10 (+/- 0.97) expressing a desire to keep the pathway permanent. Qualitative data analysed was largely positive.
Staff training levels after the first 12 months of the pathways are 84% of staff trained on ventilator use and 75% of staff with sleep study competence. Staff reported increased confidence with patients on LTV.
Discussion Through collaborative working, a pathway for stable children on LTV has been implemented. Sleep studies have been of high quality with positive feedback from patients and parent/carers. The next step is for children on long term invasive respiratory support to be admitted for sleep studies.
Morris K, Fortune PM, Paediatric Critical Care GIRFT Programme National Speciality Report 2022.
High Dependency Care for Children – Time To Move On. A focus on the critically ill child pathway beyond the Paediatric Intensive Care Unit. RCPCH 2014.
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