Surgical and anaesthetic ODNs should work with existing paediatric critically ill networks to ensure links between departments of paediatrics, surgery, anaesthesia and critical care in non-specialist paediatric tertiary centres and the corresponding specialist tertiary paediatric centres.
Hospitals that are specialist paediatric tertiary centres should have on site access to a paediatric critical care transport service commissioned for the retrieval or transfer of critically ill or injured infants, children and young people.13
Units without inpatient paediatric beds should have a formal arrangement with a neighbouring unit, to ensure that practical assistance is available should a child require transfer.9 Protocols should be in place for the rapid assessment and transfer of patients to the local specialist unit within the network.13
Onsite children’s critical care and high-dependency services should be appropriate to the type of surgery performed and the age and comorbidity of patients and should be available to support the delivery of more complex postoperative analgesic techniques.
In hospitals with no onsite paediatric high-dependency and critical-care facilities, there should be the facilities and expertise to initiate critical care prior to transfer/retrieval to a designated regional PICU/high-dependency facility. This may involve short-term use of adult/general intensive care facilities and clear pathways of communication and referral.13
Quality indicators, such as unplanned inpatient admission following day case surgery, readmission within 28 days, or unanticipated admission to PICU following surgery, should be measured, collated and analysed, and can be compared within regional networks. A number of suggested audit topics specifically relating to paediatric anaesthesia are set out in the RCoA document, Raising the Standard: A compendium of audit...
Regional ODNs could provide agreed quality standards for the perioperative care of infants, children and young people, and units should be encouraged to participate in regular collation of data relating to these standards. Participation in national audit should also be encouraged.5
Adoption of national initiatives (for example ’Hello my name is’) should be encouraged and evaluated.84
Multidisciplinary audit and morbidity and mortality meetings relating to paediatric anaesthesia and procedures, including resuscitation, should be held regularly. Perioperative death in infants and children is rare. When a death occurs within 30 days of surgery, a multidisciplinary meeting should be convened and a note made in the clinical record.15 In the event of any unexpected child death...
