title: Improving paediatric high dependency provision at a district general hospital.
abstract: Increased pressure on paediatric facilities and increased demands on staff at a district general hospital led to the development of a paediatric high dependency facility. The objective of the development was to enable more effective and efficient management of resources and to optimise care delivery. The experience of setting up a high dependency facility at the Whittington Hospital is presented in this article along with data from the first nine months of operation. Over that period 57 children needed high dependency care, fewer than were predicted based on average figures. Of these, 49 children were treated in the HDU with one being treated on adult ITU and six on the general paediatric ward. Challenges in establishing the unit included staff concerns about increased workloads, nurses feeling isolated in the HDU area and the HDU label undermining confidence in caring for these children. Education and training, team working, networking with other units and an open management approach were among the strategies used in the development and to overcome challenges. Improved data about HDU patients is essential to support the development of high dependency provision in district general hospitals.
authors.affiliation: Whittington NHS Hospital, London.
authors.forename: Colette
authors.initials: C
authors.lastname: Datt
authors.forename: Kerry
authors.initials: K
authors.lastname: Robinson
mesh_terms: D002648:Child; D002985:Clinical Protocols; D016638:Critical Illness; D004509:Education, Nursing, Continuing / Q000458:organization & administration; D006767:Hospitals, District / Q000458:organization & administration; D006769:Hospitals, General / Q000458:organization & administration; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data; D008131:London; D020380:Needs Assessment; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D010343:Patient Admission / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration; D018579:Patient Selection; D010371:Pediatric Nursing / Q000193:education / Q000458:organization & administration; D016730:Program Development / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D017749:Total Quality Management / Q000458:organization & administration*