Full Text Available
Note: Clicking the button above will open the full text document at the original institutional repository in a new window.
Developing a patient-centred care pathway for paediatric critical care in the Western Cape
Includes bibliographical references
Saved in:
| Main Author: | |
|---|---|
| Other Authors: | |
| Format: | Thesis |
| Language: | English |
| Published: |
Division of Emergency Medicine
2016
|
| Subjects: | |
| Tags: |
No Tags, Be the first to tag this record!
|
| _version_ | 1867613332673921024 |
|---|---|
| access_status_str | Open Access |
| author | Hodkinson, Peter William |
| author2 | Wallis, Lee |
| author_browse | Hodkinson, Peter William Wallis, Lee |
| author_facet | Wallis, Lee Hodkinson, Peter William |
| author_sort | Hodkinson, Peter William |
| collection | Thesis |
| description | Includes bibliographical references |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/17259 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:34:27.383Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2016 |
| publishDateRange | 2016 |
| publishDateSort | 2016 |
| publisher | Division of Emergency Medicine |
| publisherStr | Division of Emergency Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/17259 Developing a patient-centred care pathway for paediatric critical care in the Western Cape Hodkinson, Peter William Wallis, Lee Argent, Andrew Emergency Medicine Includes bibliographical references Background: Emergency care of critically ill or injured children requires prompt identification, high quality treatment and rapid referral. This study examines the critical care pathways in a health system to identify preventable care failures by evaluating the entire pathway to care, the quality of care at each step along the referral pathway, and the impact on patient outcomes. Methods: A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation until paediatric intensive care unit admission or emergency centre death, using a modified confidential enquiry process of expert panel review and caregiver interview. Outcomes were expert panel assessment of quality of care, avoidability of death or PICU admission and severity at PICU admission, identification of modifiable factors, adherence to consensus standards of care, as well as time delays and objective measures of severity and outcome. Results: The study enrolled 282 children: 85% medical and 15% trauma cases (252 emergency admissions, and 30 children who died at referring health facilities). Global quality of care was graded poor in 57(20%) of all cases and 141(50%) had at least one major impact modifiable factor. Key modifiable factors related to access and identification of the critically ill, assessment of severity, inadequate resuscitation, delays in decision making and referral, and access to paediatric intensive care. Standards compliance increased with increasing level of healthcare facility, as did caregiver satisfaction. Children presented primarily to primary health care (54%), largely after hours (65%), and were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 74% of children, indicating room for improvement. Conclusions and Relevance: The study presents a novel methodology, examining the quality of paediatric critical care across a health system in a middle income country. The findings highlight the complexity of the care pathway and focus attention on specific issues, many amenable to suggested interventions that could reduce mortality and morbidity, and optimize scarce critical care resources; as well as demonstrating the importance of continuity and quality of care throughout the referral pathway. 2016-02-25T12:06:05Z 2016-02-25T12:06:05Z 2015 Doctoral Thesis Doctoral PhD http://hdl.handle.net/11427/17259 eng application/pdf Division of Emergency Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | Emergency Medicine Hodkinson, Peter William Developing a patient-centred care pathway for paediatric critical care in the Western Cape |
| thesis_degree_str | Doctoral |
| title | Developing a patient-centred care pathway for paediatric critical care in the Western Cape |
| title_full | Developing a patient-centred care pathway for paediatric critical care in the Western Cape |
| title_fullStr | Developing a patient-centred care pathway for paediatric critical care in the Western Cape |
| title_full_unstemmed | Developing a patient-centred care pathway for paediatric critical care in the Western Cape |
| title_short | Developing a patient-centred care pathway for paediatric critical care in the Western Cape |
| title_sort | developing a patient centred care pathway for paediatric critical care in the western cape |
| topic | Emergency Medicine |
| url | http://hdl.handle.net/11427/17259 |
| work_keys_str_mv | AT hodkinsonpeterwilliam developingapatientcentredcarepathwayforpaediatriccriticalcareinthewesterncape |