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Model of Care for Paediatric Anaesthesia

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Model of Care for Paediatric Anaesthesia www.hse.ie/anaesthesia MODEL OF CARE FOR PAEDIATRIC ANAESTHESIA NATIONAL CLINICAL PROGRAMME FOR ANAESTHESIA 1 MODEL OF CARE FOR PAEDIATRIC ANAESTHESIA MODEL OF CARE FOR PAEDIATRIC ANAESTHESIA Endorsed by: Endorsed by: Irish Paediatric Anaesthesia Network Endorsed by: Irish Paediatric Anaesthesia Network Irish Paediatric Endorsed Anaesthesia by: Network Irish Paediatric Anaesthesia Network Published April 2015 PublishedPublished A April pril 2015 2015 Published April 2015 2 3 MODEL OF CARE FOR PAEDIATRIC ANAESTHESIA MODEL OF CARE FOR PAEDIATRIC ANAESTHESIA TABLE OF CONTENTS 1 FOREWORD 6 2 EXECUTIVE SUMMARY 7 3 INTRODUCTION 9 4 PAEDIATRIC ANAESTHESIA LITERATURE REVIEW 11 5 PAEDIATRIC ANAESTHESIA AND PATIENT DEMOGRAPHIC DATA FOR IRELAND 20 6 PROFESSIONAL AND CLINICAL STANDARDS FOR SAFE PAEDIATRIC ANAESTHESIA 29 7 PERFORMANCE MEASURES AND QUALITY IMPROVEMENT METHODS FOR 36 PAEDIATRIC ANAESTHESIA AND INTENSIVE CARE MEDICINE IN IRELAND 8 PAEDIATRIC CRITICAL CARE 43 9 STRUCTURE AND GOVERNANCE OF PAEDIATRIC ANAESTHESIA SERVICES: 49 LOCAL, REGIONAL/ HOSPITAL GROUPS AND NATIONAL 10 ABBREVIATIONS 60 11 MODEL OF CARE FOR PAEDIATRIC ANAESTHESIA STEERING/WORKING GROUP MEMBERSHIP 62 12 ACKNOWLEDGEMENTS 63 13 REFERENCES 65 4 5 MODEL OF CARE FOR PAEDIATRIC ANAESTHESIA MODEL OF CARE FOR PAEDIATRIC ANAESTHESIA 1. FOREWORD 2. EXECUTIVE SUMMARY FOREWORD TO PAEDIATRIC ANAESTHESIA No single service can work in isolation within the 2.1. INTRODUCTION analysed data regarding paediatric anaesthesia in ___________________________________________________ MODEL OF CARE ___________________________________________________ healthcare system. Particular focus has been given Ireland; nevertheless, the paediatric anaesthesia to clinical governance for paediatric anaesthesia The aim of the Model of Care for Paediatric and patient demographic data for Ireland section When the National Clinical Programme in at a local hospital level, across hospital groups Anaesthesia is to describe what is required in order of this document describes and discusses the sources Anaesthesia, NCPA, was set-up just over three years and nationally within the context of the clinical to establish a network to safely deliver anaesthesia to that are available – specifically, national surveys ago, we decided to focus on projects that delivered governance structures for the New Children’s Hospital children in the Republic of Ireland. and databases. We review activity data, manpower on our top three goals: Group. In order to maximise peri-operative service numbers, surgical speciality breakdown, cut-off age delivery and patient experience, the paediatric The Model of Care for Paediatric Anaesthesia limits for paediatric anaesthesia and waiting lists for • Better patient safety anaesthesia team need to work in collaboration proposes the redesign of paediatric anaesthesia day case and in-patient procedures. We conclude • Better patient care with their multi-disciplinary colleagues within clinical services, in order to provide better, safer and with a discussion on the relevance of the data. • Better collegiate support governance structures to effectively achieve better more sustainable care to children in Ireland who patient safety, better patient care and better need anaesthesia. It complements the National 2.4. PROFESSIONAL AND Clinical Standards FOR When the Irish Paediatric Anaesthesia Network (IPAN) collegiate support. Model of Care for Paediatrics, which will guide the SAFE PAEDIATRIC ANAESTHESIA ___________________________________________________ joined forces with the National Clinical Programme reorganisation of hospitals that deliver paediatric for Anaesthesia (NCPA) to collaborate on the Our thanks to all our colleagues who contributed to services; such services include paediatric surgery, The Professional and Clinical Standards for Safe development of a model of care for the delivery of this project. We were proud to work alongside such anaesthesia and peri-operative nursing care. The Paediatric Anaesthesia section opens with an Paediatric Anaesthesia throughout the country, the dedicated team players and are happy our work will National Model of Care for Paediatrics is likely to overview of the professional status of paediatric result was a model that embraced these key priorities. make such a positive contribution to the Irish Health propose a hub-and-spoke model of care, with the anaesthesia. This leads to a discussion on the current Services. new Children’s Hospital linked into three/four regional state of manpower, and recommends what will It was gratifying to lead and be part of a group centres, all of which will provide 24-hour paediatric be required for future service delivery. There is a of professionals who all gave of their time for free surgical, anaesthesia and peri-operative care. These considerable gap between current staffing levels, and contributed so much effort to this project. All three/four regional centres will in turn be linked to what is required in order to deliver current service concerned were highly motivated, dedicated _______________________________________ other hospitals in their Hospital Group areas; they requirements, and what will be required to deliver professionals who brought decades of experience Dr Bairbre Golden will provide paediatric surgery, anaesthesia, routine future service needs. to the project. Whilst much discussion and debate Director operations and peri-operative care to healthy took place during the development of the model, National Clinical Programme for Anaesthesia children of an age group that would be appropriate The section of the document also includes sub- consensus was ultimately achieved and all parties HSE for treatment in those hospitals. sections covering facilities, equipment and have taken ownership and signed off on the final medication in paediatric anaesthesia, as well as product. The high standard of this model is a fitting 2.2. PAEDIATRIC ANAESTHESIA literatURE REVIEW standards for peri-anaesthesia care and monitoring. ___________________________________________________ testament to their professionalism and enthusiasm. _______________________________________ It concludes with a description of the leadership Dr. William Casey The paediatric anaesthesia literature review section role of the anaesthetist in pre-admission units and a This Model of Care is intended to be a guide to the Chair of the document contains an extensive review of paediatric pain management service. standards and services required in order to deliver Irish Paediatric Anaesthesia Network guidelines and papers which were prepared with acceptable levels of care in paediatric anaesthesia both a national and international setting in mind. 2.5. P ERFORMANCE MEASURES AND QUALITY throughout Ireland, irrespective of whether the child Many papers relating to the provision of paediatric IMPROVEMENT METHODS FOR paediatric is being cared for in a large, paediatric-only hospital anaesthesia services have been published; we have ANAESTHESIA AND INTENSIVE care MEDICINE catering for the very sick high-risk patient or in a selected the most important and the most relevant IN Ireland ___________________________________________________ smaller Model 2 Hospital looking after the needs of materials, and, where practical, we have applied healthy low-risk paediatric patients. them to an Irish setting. We have examined guidelines The aim of Model of Care for Paediatric Anaesthesia and protocols devised in the United Kingdom, is to provide the HSE with national guidelines, and Australia and New Zealand – countries with similar establish quality improvement networks in line with the health infrastructure to Ireland. acute hospitals reform agenda and implementation of the Hospital Groups, in order to improve the 2.3. P AEDIATRIC ANAESTHESIA AND PATIENT outcome and quality of services provided to children DEMOGRAPHIC data FOR Ireland in Ireland who are undergoing anaesthesia. Currently, ___________________________________________________ there are no national guidelines on performance It is difficult to access timely, relevant and appropriately measurement or quality improvement initiatives for 6 7 MODEL OF CARE FOR PAEDIATRIC ANAESTHESIA MODEL OF CARE FOR PAEDIATRIC ANAESTHESIA 2.7. CONCLUSION paediatric anaesthesia and intensive care medicine ___________________________________________________ in Ireland. 3. INTRODUCTION There is a strong consensus among the leaders of 1.25 million (23%) of Ireland’s 4.6 million population is to design services that will improve outcomes in We have developed a suite of performance a wide range of stakeholders involved in the safe are children aged under 16 years. Ireland, which paediatric anaesthesia. The Hospital Groups’ role, measures specific to paediatric anaesthesia. They delivery of paediatric anaesthesia in Ireland of the has the highest birth rate in the European Union (16.3 on the other hand, is to reconfigure services in their can be broken down into three areas. As follows: need for a national steering group with oversight per 1,000), currently registers approximately 70,000 network and implement this Model of Care; such • To evaluate the implementation of the Model of all paediatric services throughout Ireland. This births each year. In 2013, according to Hospital In- services will include paediatric surgery, anaesthesia of Care for Paediatric Anaesthesia national steering group would comprise leaders Patient Enquiry (HIPE) scheme data, 43,207 children and peri-operative nursing care. A hub-and-spoke • Activity measures
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