Exploring paediatric dietetic resources available for critically ill children in the UK and Ireland: A multicentre survey.

critical care dietetic disparity paediatric staffing workforce ratios

Journal

Journal of human nutrition and dietetics : the official journal of the British Dietetic Association
ISSN: 1365-277X
Titre abrégé: J Hum Nutr Diet
Pays: England
ID NLM: 8904840

Informations de publication

Date de publication:
27 Nov 2023
Historique:
received: 04 08 2023
accepted: 10 11 2023
medline: 27 11 2023
pubmed: 27 11 2023
entrez: 27 11 2023
Statut: aheadofprint

Résumé

A dedicated intensive care dietitian, as part of the intensive care unit (ICU) multidisciplinary team, contributes to improved delivery of nutrition support. The Paediatric Critical Care Society recommends a minimum dietetic staffing to critical-care bed ratio of 1:10, led by an Agenda for Change (AfC) Band 7. A cross-sectional study was conducted using an electronic survey that was available for 12 weeks. The Paediatric Intensive Care Audit Network database was used to identify all hospitals with paediatric intensive care unit (PICU) beds (n = 28). Only 14% (n = 4/28) of trusts met the recommended 1:10 dietitian to bed ratio. PICU dietetic whole time equivalent was 0.7 ± 0.4, with a staff to bed ratio of 1:23.7 ± 10.7, compared to adult staff to bed ratio of 1:24.7. Some 92.8% (n = 26/28) had a AfC Band 7 Lead and only 7% (n = 2/28) had an AfC Band 8a Lead compared to adult services where 12.5% (n = 15/122) had an AfC Band 8a (p < 0.05). There is a significant disparity between adult versus paediatric services with regard to seniority of dietitians. Dietitians in well-resourced centres were more likely to review patients without the need for a referral, which may improve nutrition outcomes.

Sections du résumé

BACKGROUND BACKGROUND
A dedicated intensive care dietitian, as part of the intensive care unit (ICU) multidisciplinary team, contributes to improved delivery of nutrition support. The Paediatric Critical Care Society recommends a minimum dietetic staffing to critical-care bed ratio of 1:10, led by an Agenda for Change (AfC) Band 7.
METHODS METHODS
A cross-sectional study was conducted using an electronic survey that was available for 12 weeks. The Paediatric Intensive Care Audit Network database was used to identify all hospitals with paediatric intensive care unit (PICU) beds (n = 28).
RESULTS RESULTS
Only 14% (n = 4/28) of trusts met the recommended 1:10 dietitian to bed ratio. PICU dietetic whole time equivalent was 0.7 ± 0.4, with a staff to bed ratio of 1:23.7 ± 10.7, compared to adult staff to bed ratio of 1:24.7. Some 92.8% (n = 26/28) had a AfC Band 7 Lead and only 7% (n = 2/28) had an AfC Band 8a Lead compared to adult services where 12.5% (n = 15/122) had an AfC Band 8a (p < 0.05).
CONCLUSIONS CONCLUSIONS
There is a significant disparity between adult versus paediatric services with regard to seniority of dietitians. Dietitians in well-resourced centres were more likely to review patients without the need for a referral, which may improve nutrition outcomes.

Identifiants

pubmed: 38009404
doi: 10.1111/jhn.13267
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : None

Informations de copyright

© 2023 British Dietetic Association.

Références

PICAN (PICANET). Annual Report V1.1-22 April 2022. 2022. Available from: https://www.picanet.org.uk/wpcontent/uploads/sites/25/2022/04/PICANet-2021-Annual-Report_v1.1-22Apr2022.pdf
Valla FV, Baudin F, Gaillard Le Roux B, Ford-Chessel C, Gervet E, Giraud C, et al. Nutritional status deterioration occurs frequently during children's ICU stay. Pediatr Crit Care Med. 2019;20(8):714-721.
Eveleens RD, Hulst JM, de Koning BAE, van Brakel J, Rizopoulos D, Garcia Guerra G, et al. Achieving enteral nutrition during the acute phase in critically ill children: associations with patient characteristics and clinical outcome. Clin Nutr. 2021;40(4):1911-1919.
Tume LN, Valla FV, Joosten K, Jotterand Chaparro C, Latten L, Marino LV, et al. Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensive Care Med. 2020;46(3):411-425.
Alberda C, Gramlich L, Jones N, Jeejeebhoy K, Day AG, Dhaliwal R, et al. The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study. Intensive Care Med. 2009;35(10):1728-1737.
Braga JM, Hunt A, Pope J, Molaison E. Implementation of dietitian recommendations for enteral nutrition results in improved outcomes. J Am Diet Assoc. 2006;106(2):281-284.
Bechard LJ, Staffa SJ, Zurakowski D, Mehta NM. Time to achieve delivery of nutrition targets is associated with clinical outcomes in critically ill children. Am J Clin Nutr. 20218;114(5):1859-1867.
Twose P, Terblanche E, Jones U, Bruce J, Firshman P, Highfield J, et al. Therapy professionals in critical care: a UK wide workforce survey. J Intensive Care Soc. 2023;24(1):24-31.
Twose P, Terblanche E, Jones U, Firshman P, Merriwaether J, Rock C, et al. Protected therapy services for critical care: a subanalysis of the UK-wide workforce survey. Aust Crit Care. 2023;36:821-827.
Mehta NM, Bechard LJ, Cahill N, Wang M, Day A, Duggan CP, et al. Nutritional practices and their relationship to clinical outcomes in critically ill children-an international multicenter cohort study. Crit Care Med. 2012;40(7):2204-2211.
Mehta NM, Bechard LJ, Zurakowski D, Duggan CP, Heyland CK. Adequate enteral protein intake is inversely associated with 60-d mortality in criticall ill children: a multicenter, prospective, cohort study. Am J Clin Nutr. 2015;102(1):199-206.
Opgenorth D, Stelfox HT, Gilfoyle E, Gibney RTN, Meier M, Boucher P, et al. Perspectives on strained intensive care unit capacity: a survey of critical care professionals. PLoS One. 2018;13(8):e0201524.
Marino LV, Johnson MJ, Davies NJ, Kidd CS, Fienberg J, Richens T, et al. Improving growth of infants with congenital heart disease using a consensus-based nutritional pathway. Clin Nutr. 2020;39(8):2455-2462.
Marino LV, Magee A. A cross-sectional audit of the prevalence of stunting in children attending a regional paediatric cardiology service. Cardiol Young. 2016;26(4):787-789.
Tume LN, Ista E, Verbruggen S, Jotterand Chaparro C, Moullet C, Latten L, et al. Practical strategies to implement the ESPNIC Nutrition Clinical recommendations into PICU practice. Clin Nutr ESPEN. 2021;42:410-414.
Marino LV, Moullet C, Jotterand Chaparro C. The impact of nutrition on the clinical outcomes in the critically ill child. Paediatr Med. 2020;3:21.
British Dietetic Association. Written evidence to parliament (WBR0063). 2020 [cited 2023 Sept 29]. Available from: https://committees.parliament.uk/writtenevidence/11137/pdf/
Hickson M, Child J, Collinson A. Future dietitian 2025: informing the development of a workforce strategy for dietetics. J Hum Nutr Diet. 2018;31(1):23-32.
Rastrick S. The allied health professions (AHPs) strategy for England: 2022-2027 AHPs deliver. 2022 Available from: https://www.england.nhs.uk/long-read/the-allied-health-professions-ahps-strategy-for-england-ahps-deliver

Auteurs

Shalina Meah (S)

Imperial College London NHS Trust, London, UK.

Catherine Kidd (C)

Great Ormond Street Hospital for Children Foundation Trust, London, UK.

Brittany Rothman (B)

Great Ormond Street Hospital for Children Foundation Trust, London, UK.

V Luise Marino (VL)

Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.

Classifications MeSH