Recipient organisationAlder Hey Children's NHS Foundation Trust
Funding£1.4M
PeriodMar 2018 — Aug 2022
In plain English
AI plain-English summary
A children’s hospital is rolling out a new digital monitoring system across 240 beds to catch deteriorating patients earlier and reduce emergency transfers to intensive care. The problem is that standard ward monitoring—periodic checks recorded in an electronic patient record—can miss early signs of sepsis or serious deterioration in children. By the time a child is transferred to paediatric intensive care (PICU) or high dependency (HDU), they are often already severely ill. The DETECT study tests whether a proactive system called VitalPAC Paediatric, which uses an age-specific early warning score (PEWS) and a sepsis prompt (PS6), can change that. If the system works, the hospital expects fewer cardiac and respiratory arrests, fewer emergency PICU/HDU transfers, shorter stays when transfers do happen, and fewer cancelled major surgeries. The research also includes a health economics analysis to see whether the upfront cost of the technology is offset by savings from reduced critical care use and better outcomes. A qualitative workstream will capture what patients, parents, and clinicians actually experience with the system—ensuring it works in real life, not just on paper.
View original technical description
Participants: Paediatric tertiary hospital in-patients (240 beds). Methods/design: Stepped-wedge prospective study exploring the impact of pro-active patient monitoring on SDE, sepsis identification and emergency transfer to Critical Care. Intervention: VitalPAC Paediatric, with underpinning age-specific PEWS risk model, PS6 clinical prompt and in-built process control, Comparison: Retrospective with matched time-frame preceding year, standard in-patient monitoring (Meditech 6 electronic patient record) Primary outcomes: Emergency transfers to Critical Care (PICU/HDU): number, total bed days, severity of illness (using PRISM III), length of stay. Sepsis identification and response. Interventions (days): mechanical ventilation, non-invasive ventilation, inotropes, dialysis. Secondary outcomes: SDE: Cardiac arrests, respiratory arrests, activation of resuscitation team. Mortality (all cause). Critical care activity: Total PICU/HDU admissions, bed days, severity of illness, length of stay. Internal/external refused emergency admissions. Planned major surgery cancellations. Hospital activity: Total (ward) admissions, total bed days/month, length of stay. WP1. Site technical preparation for implementation of VitalPAC Paediatric Testing of Wi-Fi signal, interface with Meditech 6 and pathology results (PS6 clinical prompt), IT standard operating procedures (SOPs), event log. Bench/clinical testing of upgraded VitalPAC paediatric prototype. TLC/RK/GS/ IMT staff. Deliverable: Phased whole hospital implementation of VitalPAC Paediatric. Milestone: Fully functional VitalPAC Paediatric technology on in-patient wards. WP 2: Achieve compliance with pro-active monitoring of in-patients. Weekly ward feedback: timeliness/completeness of monitoring, escalation at PEWS >/=6 and response. PS6 clinical prompt compliance, incidence of SDEs, emergency transfers to Critical Care, cancelled major elective surgery. GS/RK/EC/BC/Cons Paed/research nurses. Deliverable: Process control metrics suitable for children. Milestone: Standardisation patient monitoring, improved timeliness of assessments. WP 3: Quantitative evaluation of clinical utility of VitalPAC Paediatric. Modelling of data to improve the evidence-base and clinical utility. Statistical analysis of the clinical utility of VitalPAC Paediatric in predicting serious illness; sensitivity, specificity, positive/negative predictive values. Modelling of data to determine evidence-based thresholds for vital signs and weighting of components of the PEWS risk model to improve performance. Investigate the feasibility of using stochastic control methods to track the condition of patients over-time. SL/GS/EC/ Cons Paed. Deliverable: Evidence-based age-specific PEWS risk model. Milestone: An age-specific PEWS risk model calibrated for optimal performance. WP4: Evaluation of PS6 clinical prompt Identification of children with sepsis, Compliance with the PS6 management algorithm. Emergency transfers to Critical Care with sepsis. Measure effectiveness/clinical utility of VitalPAC Paediatric Sepsis prompt to identify at-risk patients. EC/GS/SL. Deliverable: Accurate clinical and laboratory prompt to identify sepsis. Milestones: Incorporation of PS6 clinical prompt. WP 5: HE analysis of cost-effectiveness of implementing VitalPAC Paediatric Identify hospital activity data and identify and cost SDEs and emergency transfers to Critical Care, calculate implementation costs: BH/EC/GS/SL/Informatics/research nurses. Deliverable: Report of HE Analysis of VitalPAC Paediatric in a tertiary hospital. Milestones: Completion of HE analysis. WP 6:Development of a qualitative evidence base to inform and support development VitalPAC Paediatric based on the experiences of patients, parents and clinicians. BC/JP/EC/ SL/GS. Deliverable: In-depth qualitative evidence of the real-life use of VitalPAC Paediatric across different set
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