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The journey from paediatric intensive care to children's hospice
  1. Emily Harrop1,
  2. Neelam Gupta2,
  3. Susie Lapwood1 and
  4. Alison Shefler2
  1. 1Helen and Douglas House Hospices, Oxford, UK
  2. 2Paediatric Intensive Care Unit, John Radliffe Hospital, Oxford, UK

Abstract

Introduction Approximately 2/3 of PICU patients who die, do so as a result of withdrawal of treatment, most of these deaths occur on PICU. We have set out to examine referrals from PICU at the John Radcliffe Hospital, to Children's Hospices over a 5-year period.

Aims

  • Investigate year-wise trend in PICU referrals to Hospices

  • Examine the outcomes

  • Examine the process of transfer to non-hospital settings

  • Inform practice.

Methods Retrospective review of case notes for all children referred from a large tertiary level UK PICU to Children's Hospices over a 5-year period. Information was collected both from PICU and from the two hospices involved.

Results A total of 12 children were transferred, with referrals increasing over time. 2/3 of the children were aged 2–8 years, and the mean stay on PICU prior to transfer was 13 days. The average time from initial referral to transfer was 4 days. Discussions about limitation of treatment occurred after an average of 9 days of ventilation, with 2/3 of families having had prior contact with the palliative care team involved. 1/3 the patients were still on invasive ventilation at the time of transfer, and all of those were escorted by a PICU Consultant, of these, ¾ were extubated within 30 min of arrival at the hospice. Overall, eight children died following transfer, but four children (1/3) survived for > 2 weeks.

Conclusion It was pleasing to confirm an increase in joint working between PICU and Children's Hospices. Consistent with other studies, we have shown that 1/3 of children transferred for end of life care, initially survive. Information gained from reviewing these cases contributed to setting up a working party to produce a care pathway to support extubation within a children's palliative care framework, which is due to be published this year.

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