Table 2

Summary of research design and activities in each work stream

Workstream
ABCDE
Study objectiveAssociation between timeliness of arrival of PICRT and of child to PICUDescribe experience of child being transported to PICU from different stake-holder perspectivesCost-effective analysis of PICRT provision for critically ill children comparing different models in current useUsing mathematical modelling and location optimisation methods to explore whether alternative methods of service delivery for PICU/PICRT services can improve clinical outcomes without increasing costSynthesis of work streams A–D and refinement of analysis of work streams C and D through participatory workshops involving stake holder groups
Study designRetrospective analysis of linked audit dataProspective observational mix methods—questionnaires and interviewsHealth economic analysis looking at (1) number of lives saved for each strategy outlined and (2) quality-adjusted yearsTwo workshops for families in two different geographic locations. Two workshops for clinicians. In each work shop, preliminary findings from work streams will be presented and feedback from participants sort.
Data/sampleSummary records of all PICRT transfers recorded in PICANet database from January 2014 to  December 2016Parent/patient sample from all patients transferred into PICU via inter-hospital-organised transport during January 2018 to January 2019. Staff sampled from all working in PICU, PICRT and select number of DGHs in England and WalesUsing data set from work stream A combined with service costs from 2014 to 2015 NHS reference costsUsing data set from Work stream A and qualitative insights from work stream BFamily participants will have been recruited from questionnaire cohort. Clinicians invited from cohort involved in work stream B
Endpoints/OutputsMortality in PICU, at 90 days and within the first year after the index PICU admission; length of stay in PICU; resource use in PICU (days on invasive ventilation, vasoactive agent therapy, renal replacement therapy and extra-corporeal life support); length of hospital stay for the index admission; number of hospital admissions and days in hospital in the 12 months following the index PICU admission.Description of the experience of using PICRT services from parent and patient perspective;
description of the experience of working within a PICRT service;
description of the experience of working with a PICRT from the perspective of a referring and receiving hospital
Costs and benefits of different models in the short–medium and longer term;
costs and mortality at 30 days (short run analysis); cost, mortality and QALYs at 1 year following PICU admission (medium run analysis) and lifetime costs and QALYs (long run analysis)
Models that describe different methods of organising PICU/PICRT services optimising clinical outcome without increasing costsSet of policy recommendations
  • DGH, district general hospital; PICANet, Paediatric Intensive Care Audit Network; PICRT, paediatric intensive care unit retrieval team; PICU,  paediatric intensive care unit;  QALYs, quality-adjusted life years.