Children's Acute Transport Service, Great Ormond Street Hospital For Children NHS Trust, London, UK.
Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK.
BMJ Open. 2019 Jul 16;9(7):e028000. doi: 10.1136/bmjopen-2018-028000.
Following centralisation of UK paediatric intensive care, specialist retrieval teams were established who travel to general hospitals to stabilise and transport sick children to regional paediatric intensive care units (PICUs). There is national variation among these PICU retrieval teams (PICRTs) in terms of how quickly they reach the patient's bedside and in the care provided during transport. The impact of these variations on clinical outcomes and the experience of stakeholders (patients, families and healthcare staff) is however unknown. The primary objective of this study is to address this evidence gap.
This mixed-methods project involves the following: (1) retrospective analysis of linked data from routine clinical audits (2014-2016) to assess the impact of service variations on 30-day mortality and other secondary clinical outcomes; (2) a prospective questionnaire study conducted at 24 PICUs and 9 associated PICRTs in England and Wales over a 12-month period in 2018 to collect experience data from parents of transported children as well as qualitative analysis of in-depth interviews with a purposive sample of patients, parents and staff to assess the impact of service variations on patient/family experience; (3) health economic evaluation analysing transport service costs (and other associated costs) against lives saved and longer term measurements of quality of life at 12 months in transported children and (4) mathematical modelling evaluating the costs and potential impact of different service configurations. A final work stream involves a series of stakeholder workshops to synthesise study findings and generate recommendations.
The study has been reviewed and approved by the Health Research Authority, ref: 2 18 569. Study results will be actively disseminated through peer-reviewed journals, conference presentations, social media, print and broadcast media, the internet and stakeholder workshops.
在英国儿科重症监护集中化之后，成立了专门的救援团队，他们前往综合医院稳定病情，并将生病的儿童转运到地区性儿科重症监护病房（PICU）。这些 PICRT 在到达患者床边的速度以及在转运过程中提供的护理方面存在全国性差异。然而，这些差异对临床结果以及利益相关者（患者、家属和医护人员）的体验的影响尚不清楚。本研究的主要目的是解决这一证据空白。
本混合方法研究包括以下内容：（1）对常规临床审计（2014-2016 年）的相关数据进行回顾性分析，以评估服务差异对 30 天死亡率和其他次要临床结果的影响；（2）2018 年在英格兰和威尔士的 24 个 PICUs 和 9 个相关 PICRT 进行前瞻性问卷调查研究，收集转运儿童家长的经验数据，并对患者、家长和医护人员进行深入访谈的定性分析，以评估服务差异对患者/家庭体验的影响；（3）健康经济学评估，分析转运服务成本（和其他相关成本）与挽救的生命以及转运儿童 12 个月时的生活质量的长期测量值；（4）数学模型评估不同服务配置的成本和潜在影响。最后一个工作流程涉及一系列利益相关者研讨会，以综合研究结果并提出建议。
该研究已由英国健康研究机构审查和批准，注册号为 2 18 569。研究结果将通过同行评议期刊、会议演讲、社交媒体、印刷和广播媒体、互联网和利益相关者研讨会积极传播。
