KIDS INTENSIVE CARE & DECISION SUPPORT€¦ · appoint a new clinical lead – Dr Sanjay Revanna train 7 new transport nurses and 20 new transport team leaders (doctors/ANPs). present

KIDS INTENSIVE CARE &

DECISION SUPPORT

Annual Report

2015/16

KIDS Annual Report 2015/16

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REFERRAL HOTLINE 0300 200 1100

WEBSITE www.kids.bch.nhs.uk

EMAIL [email protected]

TWITTER @BCH_KIDS


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TABLE OF CONTENTS

Forward

Highlights of 2015/16

Mission Statement

Service Standards

KIDS Organisational Structure

KIDS Personnel

Activity

Geographical Location of Referring Hospitals to KIDS 2015/16

Summary of KIDS Activity 2015/16

WM Hospital Referrals to KIDS 2015/16

Out of Region Hospital Referrals to KIDS 2015/16

Referring Department Categories 2015/16

Collection Department Categories 2015/16

WM Collection Hospitals 2015/16

Out of Region Collection Hospitals 2015/16

WM Destination Hospitals 2015/16

Out of Region Destination Hospitals 2015/16

PICANet Groups of Referred Patients 2015/16

Mobilisation Times 2015/16

Grade of Team Leader

Patient Acuity


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Clinical Governance

Safety and Care Quality Monitoring

Parent and Child Feedback

Education and Training

Simulation Training

Outreach Education

Management and Leadership Developments

Away Days

Regional and National Collaboration

Events and Celebrations

Plans for 2015/16


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FORWARD

provides paediatric critical care decision support and transport for the West KIDS

Midlands. is hosted by Birmingham Children’s Hospital NHS Foundation Trust KIDS

(BCH) in collaboration with University Hospital of North Staffordshire NHS Trust

(UHNS). The service is based at 1 Printing House Street, Birmingham – adjacent to the

main BCH campus.

serves the 20 District General Hospitals in Staffordshire, Shropshire, Birmingham KIDS

and the West Midlands, Coventry, Warwickshire, Herefordshire and Worcestershire.

Two paediatric intensive care units (PICS) operate within the West Midlands – one at

BCH and one at UHNS in Stoke-On-Trent.


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HIGHLIGHTS OF 2015/16

2015/16 saw KIDS

appoint a new clinical lead – Dr Sanjay Revanna

train 7 new transport nurses and 20 new transport team leaders

(doctors/ANP’s).

present 4 posters and 1 oral presentation at the Retrieval 2016 conference, in

Glasgow.

deliver 3 Stabilisation of the Sick Child study days and 3 RAPT (Regional Acute

Paediatrics Training)

actively prepare for a merge with the West Midlands Newborn Transport

Service.

award the ambulance contract for and the WMNTS to St. John Ambulance KIDS

in preparation for the services merger.


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KIDS Mission Statement

To provide the right solution, at the right time, and in the right place, for babies,

children, and young people and their families with critical care needs throughout the

region, with timely high quality decision support, PIC bed finding and critical care

transport.

KIDS Service Standards

1. will comply with the Paediatric Intensive Care Society Standards (2010) – KIDS

‘Retrieval and Transfer of the most critically ill children.’

2. will maintain core infrastructure operational 24 hours per day, 365 days of KIDS

the year, including:

i. Operations Centre staffed with trained administrators and dedicated single

referral telephone number;

ii. Trained Transport Team;

iii. Fully maintained transport equipment, drugs and disposables.

3. On-site dedicated bespoke critical care ambulances and trained drivers;

4. The referral line will be answered within 5 rings;

5. The referrer will be connected to the Consultant within 5 minutes; KIDS

6. will comply with the appropriate policies and procedures of BCH; KIDS

7. will participate in all care quality surveillance and improvements processes KIDS

including clinical governance, mandatory training, infection control,

documentation, child protection and patient experience;


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8. will use standard operating procedures (SOPs) for informing service KIDS

delivery. These will be held on the BCH Intranet, with indexing and version KIDS

control;

9. The KIDS website will be maintained with service information, clinical guidelines,

drug calculator and feedback mechanisms in place;

10. will maintain close working relationships with PIC at BCH and UHNS; KIDS

11. will relentlessly pursue continual improvements in the delivery of best for KIDS

patients and families. This will include care quality, patient experience, capacity

management, medicine, nursing, administration, ambulance provision,

information technology, telecommunication, research, innovation, risk

management, education, leadership and customer service.


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KIDS ORGANISATIONAL STRUCTURE

KIDS

(BCH Urgent & Critical Care

Directorate)

KIDS Clinical

Lead

KIDS Senior

Sister

Administration

Team Leader

Sessional

Consultants

KIDS Registrars

& Fellows

KIDS Consultants

KIDS Lead Nurse

KIDS ANPs

Rotational

Nurses

KIDS Junior

Sisters/Charge

Nurses

KIDS Volunteer

Call Centre

Administrators

SJA Team Leader

KIDS ANP

Trainee

SJA Technichians


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KIDS Personnel 2015/16

KIDS Consultants

Dr Mary Montgomery

(Clinical Lead until Jan 2016)

Dr. Sanjay Revanna

(Clinical Lead from Feb 2016)

Dr. Intikhab Zafurallah

Dr. Balazs Fule

Dr. Edgar Brinkat

Dr Aravind Kashyap

BCH Sessional Consultants

Dr. Annemieke Miedema

Dr. Barney Scholefield

Dr. Gale Pearson

Dr. Fiona Reynolds

Dr, Dave Ellis

Dr. Steve Cray

Dr. Tina Newton

Dr. Linda Edwards

Dr. Reinout Mildner

Dr Hari Krishnan

UHNS Sessional Consultants

Dr. Mark Bebbington

Advanced Nurse Practitioner

Anneke Gyles

Advanced Nurse Practitioner Trainee

Sarah Webb

Advanced Nurse Practitioner (PICU)

Steve Cossey

Rachael Morrison

Hannah Roge

Claire Fitzsimons

KIDS Fellows / Registrars

Dr. Joseph Tyler

Dr Neil Tiwari

Dr Elin Jones

Dr. Laura Troth

Dr. Claire Bosanko

Dr. Tom Billyard

Dr. Ahmed Mesbah

Dr. Cathy Gibbons

Dr. James Chinnery


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PICU Registrars / Fellows on rotation

Other Fellows / Registrars

Dr. Justin Wang

Dr. Chris Flannigan

Dr. Anis Abidin

Dr. Rohit Saxena

Dr. Nikki Kelly

Dr. Catherine Snaith

Dr.George Kourelis

Dr. Samarth Burle

Dr. Pazlida Pauzi

Lead Nurse

Emma Bull

Senior Sister

Sarah Taylor

KIDS Junior Sisters (B6)

Kelly Robinson

Jackie Somerfield

Joanne Webb

Louise Kelly

Elizabeth Lloyd

UHNS PICU Rotational BCH PIC/KIDS Junior Sisters/Charge Nurses (B6)

Rebecca Fry

Sharon Hale

Kate Evans

BCH PICU Rotational Staff Nurses

Philip Ward (B6)

Danielle Jones (B5)

Emily Wyres (B5)

Rachel Bennett (B5)

Junior Sisters

(B5/6)

Sue Dodd

Candi Martin

Rebecca Middleton

Elizabeth Lloyd

Leanne Lovatt

Sarne Rushton

Claire Sidley

Sonjia Robinson


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KIDS Operations Centre

Call - Centre Team Leader (B4)

Hayley Osmani

KIDS Governance Support Administrator

(B4)

Rachel Boffin

Administrators (B3)

Richard Murphy

Lorraine Rooker

Sabina Mughal-Hussain

Sarah Slaughter

Mathew Weir

Christopher Rodgers

Aimee Haynes

Charmaine Kush

KIDS Volunteer

Pam Kumar

St John Ambulance Services Operations

Manager- West Midlands Region

Samantha Fawcett

Ambulance Technicians

Alan Jinks

Anthony Hancock

Anthony McLaughlin

Christiaan May

Darren Elgerton

Jayne Wilson

John Chatton

Kevin Haggett

Margaret Herbert

Matthew Phillip

Paul Colton

Pawel Luczak

Phil Bone

Phil Sprigg

Ray Edwards

William Byrne


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Activity

Geographical Location of Referring Hospitals to KIDS 2015/16

KIDS Summary of KIDS Activity 2015/16

Location of referral

No.

West Midlands Hospitals 1310

Out Of Region Hospitals 160

Total Referrals 1470

Outcome

No.

KIDS Transfers – Total Non-Elective 516

KIDS Tansfers – HDU (Non-Commisioned) 34

KIDS Transfers – Palliative (Non-Commisiond) 5

KIDS Transfers – Total Elective 27

KIDS Nurse Only 51

NTS Transfer 114

CNN Transfer 21

Referring Team Transfer 95

Other Paediatric Retrieval Team Transfer 34

Other Neonatal Retrieval Team Transfer 10

Not Transferred 563

Total Referrals 1470


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West Midlands Hospital Referrals to KIDS 2015/16

0 50 100 150 200 250 300

Birmingham Dental

Queen Elizabeth

WMNTS

Royal Orthopaedic

Shrewsbury

Stafford

George Elliot

Warwick

Queens Burton

Reddich

Royal Stoke

Good Hope

Hereford

Birmingham City

Sandwell

Worcester

Telford

New Cross

Walsall

Russells Hall

BWH

Heartlands

Coventry

BCH

West Midlands Hospital Referrals to KIDS 2015/16

West Midlands Hospital Referrals toKIDS 2015/16


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0 5 10 15 20

Broomfield

Newcastle Freeman

Boston Pilgrim

Peterborough

Kings Mill

Royal Derby

WMNTS

Bradford

Chester

Salford

Chelmsford

Southampton

Gloucester

Leeds

Kings College

Devon

Preston

ANTS

Wrexham

WATCH

EMBRACE

Glasgow

Hull

John Radcliffe

Cardiff

Alder Hey

Manchester

Gwent

Other

Trauma Desk

Belfast

CeNTRE

Bristol

Derby

CATS

GOSH

Kettering

NWTS

Leicester Glenfield

Leicester Royal

Northampton

Queens Medical Centre


Out of Region Hospital Referrals toKIDS 2015/16


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0 50 100 150

ITU

Theatre

PICU

HDU

NICU

ED

Ward


Referring Department Categories2015/16

0 20 40 60 80 100 120 140 160

ITU

Theatre

PICU

HDU

NICU

ED

Ward


Collection Areas


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West Midlands Collection Hospitals 2015/16


0 10 20 30 40 50 60 70 80

Royal Orthopaedic

Shrewsbury

Stafford

George Elliot

Royal Stoke

Queens Burton

Hereford

Birmingham City

Warwick

Sandwell

Good Hope

Reddich

Telford

Worcester

New Cross

BWH

Walsall

Heartlands

Russells Hall

BCH

Coventry



0 1 2 3 4 5

Broomfield

Newcastle Freeman

Kings Mill

Leicester Glenfield

Leicester Royal

QMC Nottingham

Peterborough

Boston Pilgrim

Roay Derby

Northampton

Kettering


Out of Region Collection Hospitals2015/16


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West Midlands Destination Hospitals 2015/16


0 50 100 150 200 250 300

Queen Elizabeth

Sandwell

Telford

Worcester

Birmingham City

New Cross

Russells Hall

Coventry

Heartlands

BWH

Royal Stoke

BCH

West Midlands Destination Hospitals 2015/16

West Midlands DestinationHospitals 2015/16

0 5 10 15

Bristol St. Michaels

St. Thomas's

Cardiff

Alder Hey

Sheffield

Great Ormond Street

Newcastle Freeman

Addenbrookes

Manchester Children's

Leicester Glenfield

Bristol Children's

John Radcliffe

Leicester Royal

Queens Medical Centre


Out of Region DestinationHospitals 2015/16


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Mobilisation Times 2015/16

Mobilisation time is defined as the time from when the decision to retrieve the patient

is made by the consultant is made to the team departing to retrieve the KIDS KIDS

patient. The target time is less than 30 mins minutes. This data is reported KIDS

monthly with all delays recorded and reviewed at the daily morning meeting. KIDS

On average this target is achieved 72% of the time.

The most common reason for not achieving this target is the team already being out on

another retrieval.


Blood/Lymph Body Wall/Cavity Cardiovascular Endocrine/Metabolic Gastrointestinal

Infection Multisystem Musculoskeletal Neurological Oncology

Opthalmology Respiratory Trauma Other Unknown


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Grade of Team Leader for all Non-Elective Transports 2015/16

teams comprise of a clinical team leader, a retrieval trained PIC nurse and an KIDS

ambulance technician.

The team was led by an Advanced Nurse Practitioner on 24% of transfers and a

Consultant either led or accompanied the team either due to patient acuity of to

supervise new trainees on 31% of transfers.

Patient Acuity 2015/16

Grade of Transport Team Leader 2015/16

Consultant

Advanced Nurse Practitioner

ST 1-3

ST 4-8

Intervention % of transfers

Invasive Ventilation 68

Vasoactive Agent 20

Inhaled Nitric Oxide 1.6

Clinical Governance

Adverse Incident Reporting:

report incidents using the incident reporting system at BCH. Threshold KIDS

for incident reporting is low – resulting in high volume of incidents reported

(One of the highest in the Trust, despite small size of ). This reflects KIDS

healthy reporting culture, and is encouraged. Incidents are reported as

relating to team (equipment/communication/clinical and other) or KIDS

relating to referrer activities. Management of the non-KIDS incidents – i.e.

those relating to referrer activities – can be difficult to classify due to the

nature of the reporting system and field designation. work closely with KIDS

the BCH Governance department to assist in clarifying designation as ‘ ’ or KIDS

‘other hospital’ incidents, and continue to work towards developing a system

for managing ‘non-KIDS’ incidents.

Daily review of all cases referred (whether transferred or not) is performed by

the MDT in the morning meeting. Any issues are raised at this meeting. Issues

relating to are managed in a timely fashion through the existing channels KIDS

(depending on nature of issue: equipment, clinical, team working,

communication). Issues relating to ‘non-KIDS’ activities are fed back directly to

the referring centre.

Monthly incident reporting is to the Directorate Management Team, with

scrutiny of patterns or significant incidents.

attends and reports to SIRI/RCA at BCH for any patients withKIDS KIDS

involvement.

hold monthly M&M meetings as well as attending and reporting to BCH KIDS

PIC monthly M&M. Any cases requiring higher level scrutiny are discussed with

the BCH Governance department and BCH Leads for governance for guidance

and scrutiny.

KIDS Annual Report 2015/16 22

Safety and Care Quality Monitoring

always ensures an open and honest governance structure, with a high KIDS

level of reporting of incidents independent of clinical sequelae. The high level

vigilance of ensures physical resources are in a state of readiness and that

minor deviations of standard practice are recognised and addressed swiftly.

submits data to the Paediatric Intensive Care Audit Network (PICANet), KIDS

the national audit of paediatric intensive care activity. Reports from PICANet

allow to benchmark the service against other paediatric intensive care KIDS

transport services in the UK.

framework for ensuring safety and care quality are maintained by KIDS

ensuring;

Strong, stable management team focussed on effective and progressive

clinical leadership.

Thorough recruitment process – building a skilled, professional,

motivated and stable team.

Comprehensive training and annual reaccreditation.

Standard Operating Procedures available on BCH Intranet Site KIDS KIDS

Well-resourced and effectively managed equipment store, with on-line

manuals, teaching packages, repair and maintenance plans empowering

all staff to address problems.

Equipment checks, vehicle checks, operations centre checks monitored.

Audit of Critical Incidents, risk register and serious incidents. KIDS

Audit of Mobilisation, stabilisation, transport duration times and ‘blue

light’ usage.

Implementation of all BCH care quality surveillance monitoring; Infection

Control, Child Protection, Documentation, Patient Experience and

Referrer Experience.


Parent and Child Feedback - Child and Family Steering Group

continued to gain all types of feedback received from patients and KIDS

parents, in order to gain a more critical insight of the issues they face when

their family experiences a critical care transport.

Some examples of feedback received from parents;

"Impressed with care and professional handover, best transfer my child has had!"

“Thank you to the team! He got here safely thanks to you all!”

“Couldn't have done anything better, you were amazing!”

“Wow! Teddy was great & drink! Got this last time! Thank - you are all brill, as usual!”

“Impressed by care and professional handover, best transfer she has had.”

“Thank you for letting me travel, teddy is so cute he will love it.”

“Felt she was well taken care of Thank you.”

Themes within feedback received during the year 2015/16 continues to be

about the parent snack packs (that were introduce in the year 2013/14 on the

back of parent feedback) and the professional manner of the team and KIDS

their calm and caring natures.


Education and Training

trained and signed-off 20 new clinical team leaders (18 registrars/clinical KIDS

fellows and 2 PIC ANP’s) and 7 nurses in transport during 2015/16. This was

achieved through in –house training days and 1:1 training from KIDS

consultants and senior nurses.

continues to provide placements for other healthcare students and other KIDS

healthcare professionals (doctors, nurses and paramedics) to observe the KIDS

team at work. Feedback remains positive about as a learning KIDS

environment for paediatric transport, service coordination and team-working.

Demand for places continues to rise.

Simulation Training

Dr Zafurallah continues leads on delivery of the simulation programme with

assistance from Junior Sister Louise Kelly and other members of the KIDS band

6 nursing team. The high fidelity SimBaby owned by is used for training of KIDS

staff at and throughout the region. It is an effective tool for delivery of KIDS

real time scenarios.

Dr Zafurallah and a team of nurses trained in simulation use SIM KIDS

frequently to delivery training around human factors and crew resource

management, improving team working in complex and stressful environments.

This training is not only provided for team members but also for the KIDS

region through the Stabilisation of the Sick Child study days and the RAPT days,

providing ‘in-situ’ simulation for the district general hospitals.


In October 2015 the team attended the Simulated interPRofessional KIDS

Team Training (SPRinT) programme introductory facili-tators course. It was well received by all, with new skills being developed and practiced,

including the Harvard style advocacy and enquiry for debriefing and crisis

resource management.

Outreach Education

delivers, within its available resources, outreach education to many of the KIDS

district general hospitals (DGH) across the region. Requests for outreach

education are regularly received and are commonly cited on the ‘feedback

questionnaires’ received from hospitals after each transport.

….outreach sessions were held during 2015/16

The ‘Stabilisation of the Sick Child’ study day was run on 3 occasions during

2015/16 to a multidisciplinary audience of doctors and nurses from around the

West Midlands region.

The RAPT course was taken to the region’s DGH’s on 3 occasions during

2015/15 and provided high fidelity in-situ simulation, allowing the hospital’s to

test their own processes under the safety of the simulation umbrella.

Management and Leadership Development

In February 2016 Dr Sanjay Revanna was appointed as the Clinical Lead for

as Dr Mary Montgomery was appointed to the role of Clinical Director for KIDS

the Urgent and Critical Care Directorate at BCH.

Also in February 2016 Dr Andrea Cooper was appointed as a 50/50 Locum

Consultant for and BCH PICU. KIDS


Away Days

The Team had a joint multi-disciplinary away day with the WMNTS in KIDS

January 2016.

The Admin away day took place on Thursday 10th September at Drayton KIDS

Manor Hotel.

Research and Audit

team members presented 5 posters at the 29th Paediatric Intensive KIDS

Society Conference in September 2015 in Birmingham.

regularly undertakes internal audits of their practice to ensure a quality KIDS

service delivery.


Regional and National Collaboration

WM Newborn Transport Service (WMNTS)

and the WMNTS continued to work towards a merger and held an away KIDS

day in January 2016 to work through some of the practical aspects of merging

the 2 teams which is planned for July 2016.

Continuing Professional Development and External Work

ANP Anneke Gyles continues to sit on the working group for the ALSG KIDS

transport course NAPSTaR.

Events and Celebrations

On Tuesday 8th September 2105, KIDS were invited to showcase a vehicle in

Victoria Square in support of the annual St John Ambulance 'Save A Life

September' campaign.

The ambulance was set up with an 'intubated' Resusci Junior to give the public

a realistic view of the patients that may be on board as they see our vehicles

passing them on the roads of the West Midlands.

The display was staffed throughout the day by members of the KIDS team and

St. John Ambulance Technicians. The day was a great success for both KIDS and

St John that saw a lot of interest in the ambulance and the KIDS service in

general. More than 3000 free First Aid guides given out during the day.


Plans for 2016/17

Full merger of and WMNTS. KIDS

Further development of the ANP team. KIDS

Develop outreach teaching to involve ‘in-situ’ simulation.

Documents

KIDS INTENSIVE CARE & DECISION SUPPORT€¦ · appoint a new clinical lead – Dr Sanjay Revanna train 7 new transport nurses and 20 new transport team leaders (doctors/ANPs). present