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Critical Care Adolescent Patient Pathway

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During periods of peak activity when Paediatric Intensive Care is operating at, or near, maximum bed occupancy it may be appropriate for adolescent patients requiring critical care to be looked after in the co-located Adult Critical Care Unit in the QEUH. This patient pathway has been designed to improve the safety and quality of the patient journey for those adolescents identified as suitable for, and agreed for transfer between PICU and Adult ICU. It is also to facilitate shared learning in adolescent management across critical care areas in the adult and children’s hospital.

Suitable patients
  • Patients aged 13-16 years of age
  • Pathology not requiring significant acute input from paediatric specialist teams
  •  Adolescent specific pathologies e.g. alcohol and drug ingestion
Intensive care: Clinical responsibility

Adult ICU is a closed unit: paediatric patients admitted to ICU from A+E will admit under an adult ICU consultant bed card.

Adult ICU consultants will assume clinical responsibility but with support as required from PICU team for paediatric issues or concerns.

Pathway from ED to adult ICU
  • Any patient aged 13-16 years presenting to A+E and requiring intensive care support should be assessed, resuscitated and stabilised with PICU team as per current practice.
  • PICU consultant should refer and agree admission to adult ICU with adult intensive care consultant on-call.
  • Handover of care to be agreed between PICU and ICU: either in A+E or PICU to transfer to ICU. PICU or ICU staff should remain present in A+E pending transfer to ICU.
  • PICU to inform relevant paediatric team of admission to ICU (General paediatric consultant/senior registrar #85735 or Specialty team)
  • Any patient admitted to ICU should be added to the medical paediatric handover and highlighted at the hospital huddle.
Transfer between PICU and adult ICU
  • Any patients moving from PICU to ICU at times of bed crisis are to be agreed between PICU and adult ICU consultant on-call. Any involved specialty teams should be made aware of the transfer.
  • PICU should remain aware of any paediatric patient in adult ICU and keep on ‘watcher’ list
  • PICU patients looked after in adult ICU should be highlighted at daily hospital huddle
  • PICU consultant should phone or go through to ICU for daily update and to offer assistance if required
  • Daily discussion between adult ICU and PICU consultant should take place to anticipate whether the patient is suitable to complete ICU care in adult ICU or whether they should transfer back to PICU when bed is available
Adult HDU
  • Adult surgical HDU is managed by adult ICU consultants
  • Adult medical HDU is managed differently: at times will be managed by adult ICU consultants and other times managed by non-intensivists. It is not covered by ICU staff at the weekends.
  • This may not be the safest environment for a 13-16 year old requiring level 2 care and if considered would need close discussion between adult ICU consultant, PICU consultant, medical/A+E consultant
Trauma/surgical patients
  • Polytrauma patients with on-going involvement from paediatric surgery should be managed in PICU whenever possible.
  • Any surgical specialty patients considered for movement to ICU should be discussed and agreed with the on-call surgical consultant, adult ICU and PICU consultant prior to movement.
Social issues
  • All paediatric patients admitted with drug or alcohol use should have a notification of concern form filled out. This is usually done by A+E staff.
  • All Paediatric patients admitted to Adult ICU with drug or alcohol related issues will step down to medical paediatric team prior to discharge home.
Step-down from ICU
  • All patients who are fit for discharge from adult ICU will step down to relevant Paediatric specialty. No patient < 16 years old should step down to an adult non-ICU ward.
  • General medical patients should step down under the ‘Hot’ general medical consultant by consultant discussion from ICU using #85735. The adult intensive care team requested that all paediatric patients be stepped down to a paediatric ward prior to discharge home for paediatric review and/or CAMHS review prior to discharge. It is accepted that some patients might be discharged by the paediatric team shortly after step-down (e.g. medically fit, recreational drug/alcohol ingestion).
ScotSTAR retrieval calls
  • Adolescent patients referred via ScotSTAR for retrieval to PICU at times of high bed capacity and who may therefore be looked after in Adult ICU should be considered for transfer on a case by case basis. It may be safer and more appropriate that they be looked after in the adult ICU at referring hospital with appropriate support from PICU/ScotSTAR.
  • Complex patients who require tertiary ICU care may be considered for transfer to adult ICU at QEUH if deemed appropriate after discussion and agreement between referring centre, ScotSTAR clinician, PICU and adult ICU consultants.
Allied Health Professionals
  • When cared for in adult ICU it is expected that the adult AHPs will lead the daily care of any adolescent falling under the remit of this pathway.
  • When transferring between PICU and ICU any active care plans from AHPs should be communicated between treating specialists to maintain consistency of care.
  • Paediatric AHPs will expect to provide an active advisory role for any paediatric related issues that their adult colleagues may wish to discuss.
Audit and review of process
  • Data will be collected and audited for all patients <16 years old admitted to adult ICU to inform annual review with adolescent group and to highlight things that work well and challenges with any of these patients.
  • Cheryl Gillis (PICU consultant) will act as point of contact for any data and feedback.
  • We anticipate that this pathway will facilitate opportunities for shared learning and education.
Contact numbers
  • General Medical consultant 85735
  • ED consultant 84059
  • General PICU consultant 84719 (Out of hours if unavailable on 84719 can be reached on mobile via switchboard)
  • 3rd on PICU consultant 84686 (Mon-Thurs 8am- 8pm)
  • PICU Nurse in Charge 84713
  • PICU Physiotherapist 84730
  • PICU Dietician 84731
  • PICU Pharmacist 84728
  • Adult ICU consultant 83081 (Consultant 0800-0000, Senior trainee 0000-0800)
  • Adult ICU Nurse coordinator 83082
Editorial Information

Last reviewed: 01 October 2021

Next review: 31 October 2023

Author(s): Dr Cheryl Gillis, Consultant Paediatric Intensivist

Version: 1

Approved By: PICU Guidelines Group