Children's Acute Transport Service clinical outcomes

Clinical outcomes are broadly agreed, measurable changes in health, function or quality of life that result from our care. Constant review of our clinical outcomes establishes standards against which to continuously improve all aspects of our practice.

About the Children's Acute Transport Service

The Children's Acute Transport Service (CATS) is a specialised service designed to quickly and safely transport critically ill children between hospitals in the North Thames and East Anglia regions. The CATS team is hosted and located at Great Ormond Street Hospital (GOSH).

Paediatric intensive care is only provided in a small number of hospitals across the North Thames and East Anglia regions. However, children can become critically ill in hospitals where there is no paediatric intensive care unit. Where this is the case, the CATS team travel to the hospital required, start intensive care support for the child and then provide safe and speedy transfer of the child to a hospital with a paediatric intensive care unit.

The CATS team is the largest dedicated children’s intensive care transport team in UK. They stabilise and safely transfer more than 1,100 sick babies and children each year to paediatric intensive care units across London. The main units are at GOSH in Holborn, St Mary’s Hospital in Paddington, Royal Brompton Hospital in Chelsea, Royal London in Whitechapel and Addenbrooke's Hospital in Cambridge. Children are sometimes transferred to Evelina Children’s Hospital in Westminster, St George’s Hospital in Tooting, and King’s College in Denmark Hill.

CATS aims to provide the highest quality paediatric intensive care for patients and their families, from the point of referral at the hospital they are in, to the handover of care at the paediatric intensive care unit that they are going to.

Clinical Outcome Measures

1. Mobilisation time

The CATS team has developed service standards to ensure it provides the highest quality of care to patients and their families. One of these service standards is the time it takes to get a team ready to go once the decision to accept a patient has been made. This is known as the mobilisation time.

Timely mobilisation ensures that the CATS team can arrive at the hospital site to start intensive care for the patient, and are in a position to safely transport a child to where is required as quickly as possible. We report below the proportion of patient transports (retrievals) where the team departs the transport base within 30 minutes of accepting a referral. For April 2018 to March 2019 the CATS team mobilised within 30 minutes for 65.1% of patient transports, this increased from 56.0% in 2016/17. We monitor mobilisation times, however during busy periods (eg winter months) the CATS team may be retrieving another patient when a new referral has been accepted. All patients continue to receive the highest quality of care whilst waiting for the CATS team to become available. This measure is a national measure that is reported to commissioners by paediatric intensive care transport services.

Numerator: Number of retrievals (of a patient) where the team departs the transport base within 30 minutes from the time the referral is accepted.

Denominator: Total number of emergency retrievals (of a patient) undertaken.

Table 1.1 Proportion of patient retrievals within 30 minutes of referral being accepted, 2016/17 to 2018/19

Year

Number of patient retrievals where the team departs the transport base within 30 minutes from the time the referral is accepted

Total number of emergency patient retrievals undertaken

Percentage of patient retrievals where the team departs the transport base within 30 minutes from the time the referral is accepted

2016/17 667 1,192 56.0%
2017/18 734 1,222 60.1%
2018/19 769 1,181 65.1%

2. Refused Requests for Retrieval

At times of peak demand for paediatric intensive care services (mainly in winter months) the CATS team may on occasion be unable to transport a patient. In this event the patient’s condition is assessed. The patient may then be referred to another nearby transport service, or continue to be cared for at the local hospital while waiting for the CATS team (or other transport service) to become available. All patients are monitored to ensure they receive the highest quality care.

We report the proportion of refused requests for transport (retrieval) of a patient, within our defined catchment area. Overall, between April 2014 and March 2019, just under 5% of requests were refused.

This measure is a national measure that is reported to commissioners by paediatric intensive care transport services.

Numerator: Number of requests (within defined catchment of retrieval service) for retrieval of a patient requiring paediatric intensive care admission that are refused.

Denominator: Total number of requests (within defined catchment of retrieval service) for retrieval of a patient requiring paediatric intensive care admission.

Table 2.1 Proportion of refused requests for retrieval of a patient (within defined catchment area), 2014/15 to 2018/19

Year

Number of refused requests for retrieval of a patient requiring paediatric intensive care admission (within defined catchment area)

Total number of requests for retrieval of a patient requiring paediatric intensive care admission (within defined catchment area)

Proportion of refused requests for retrieval of a patient requiring paediatric intensive care admission (within defined catchment area)

2014/15

96

2,303

4.2%

2015/16

148

2,418

6.1%

2016/17

128

2,426

5.3%

2017/18

114

2,386

4.8%

2018/19

102

2,359

4.3%

Total

588

11,892

4.9%

3. Critical Incidents 

In the transportation of critically ill children, incidents that impact on patient care can occur. Our aim is to prevent these events by monitoring their occurrence and analysing the reasons they happened, in order to make service improvements and reduce the likelihood of the same incident occurring again.

We report here critical incidents impacting on patient care that occurred during journeys undertaken by CATS for emergency patients. Overall, between Jan 2015 and Dec 2017, there were no critical incidents in 91.8% of emergency transports. This is similar to the national equivalent figure of 89.9%.

Table 3.1 Number and percentage of critical incidents for emergency transports, 2015 to 2017

Total number of emergency transports

3,147

No critical incidents reported

2,889 (91.8%)

Accidental extubation

10 (0.3%)

IV access loss

8 (0.3%)

Cardiac arrest

25 (0.8%)

Ventilator failure

5 (0.2%)

Medical gas supply loss

8 (0.3%)

Equipment failure

148 (4.7%)

Vehicle accident or breakdown

0 (0.0%)

Other* 62 (2.0%)

* 'Other' category includes: Incidents during Transit for- Chest Drain, Delayed Connection, Desaturation, Emergency Diversion, Hypotension, Inotrope Loss, Intubation Transit, Journey Abandoned, Medication Administrative Error, Oxygen Saturation Loss, Replacement Vehicle, Team Diverted and Other reason.

Published with the permission of PICANet from “Paediatric Intensive Care Audit Network Annual Report 2018 (published Nov 2018): Universities of Leeds and Leicester.”

This information was published in September 2019 and will be updated in September 2020.