Summary of research design and activities in each work stream
| Workstream | |||||
| A | B | C | D | E | |
| Study objective | Association between timeliness of arrival of PICRT and of child to PICU | Describe experience of child being transported to PICU from different stake-holder perspectives | Cost-effective analysis of PICRT provision for critically ill children comparing different models in current use | Using mathematical modelling and location optimisation methods to explore whether alternative methods of service delivery for PICU/PICRT services can improve clinical outcomes without increasing cost | Synthesis of work streams A–D and refinement of analysis of work streams C and D through participatory workshops involving stake holder groups |
| Study design | Retrospective analysis of linked audit data | Prospective observational mix methods—questionnaires and interviews | Health economic analysis looking at (1) number of lives saved for each strategy outlined and (2) quality-adjusted years | Two 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/sample | Summary records of all PICRT transfers recorded in PICANet database from January 2014 to December 2016 | Parent/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 Wales | Using data set from work stream A combined with service costs from 2014 to 2015 NHS reference costs | Using data set from Work stream A and qualitative insights from work stream B | Family participants will have been recruited from questionnaire cohort. Clinicians invited from cohort involved in work stream B |
| Endpoints/Outputs | Mortality 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 costs | Set 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.