Improving outcomes and reducing the incidence of deterioration in the acutely ill infant, child or young
Dr Damian Roland, Consultant and Honorary Senior Lecturer in Paediatric Emergency Medicine at the University Hospitals of Leicester and Leicester University introduces Re-ACT, the Respond to Ailing Children Tool, and the knowledge map for healthcare professionals wishing to improve the recognition and management of the deteriorating child:
Research shows that failure to recognise and treat patients whose condition is deteriorating is a cause of significant unintended harm in healthcare environments. This is especially tragic for children and young people who often do not have significant co-morbidities and so mortality is often preventable.
There are multi-factorial reasons why deterioration in children is missed but they can be clustered into themes
- Parent/carer engagement: Often the concerns of parents are not heeded or parents are not equipped or confident to raise their fears
- Healthcare professionals training: The low incidence of serious illness means it is possible to become de-skilled in many aspects of recognition and reaction. Observation is a key component of paediatric practice. Health care professionals require exposure to the often subtle signs of breathing difficulty or change in behaviour in safe and educational environments in order to be able to recognise them as independent practitioners.
- Not responding to physiological changes: It is well recognised that physiological parameters often deviate from normal in the hours before collapse.
- Systems failure: A variety of Human Factor and Implementation issues often combine to create a paradigm where mistakes are missed or responses are too slow.
In order to reduce the complexity in responding to these issues NHS England have collated, curated and created a number of resources to aid students, healthcare professionals, managers, directors and organisations to aid the recognition of and response towards ill children and young people. These include films for parents and families, expert talks, webinars and documents and presentations.
The resources are to be found via the links below:
- Improving Common Language and understanding parental concern as an indicator
- Empowering Parents/Carers to speak up
- Involving parents/carers/patients in design and co-production
- Reducing variability in core skills around recognition of illness
- Improving communication with families
- Understand child and family factors in recognising deterioration
- System intervention to aid recognition and response
- Implementation guides
- Human factors resources
- Learning from incidents and investigations
- Practicalities of design and deployment
- What works, where and when: Paediatric Early Warning Score/System (PEWS)
“Deterioration, particularly in infants, children and young people, requires rapid intervention to ensure a life can be saved. These new resources not only provide extra support to help staff recognise and respond to signs of deterioration in this vulnerable patient group, but also supports families to speak up if they feel something isn’t quite right. I’m sure these resources will be welcomed by staff and especially families as they play their vital part in improving safety.” Dr Mike Durkin, Director of Patient Safety, NHS England.
“Meningitis Now is delighted to support the work on ReACT, the deteriorating children programme. It is work that seeks to improve outcomes for children through the early recognition of serious illness and rapid response which is so critical for meningitis which can kill in hours”. Sue Davie, Chief Executive of Meningitis Now.
“As children’s health professionals we all work hard to do our best, and to prevent tragedies from occurring. But we know that more can be done. ReACT is a valuable practical resource to help us all focus on improving safe care for children“. Dr Ingrid Wolfe, author of Why Children Die Consultant Paediatric Public Health Medicine, Evelina London Children’s Hospital Clinical Senior Lecturer, King’s College London Co-Chair, British Association for Child and Adolescent Public Health.