THE RATE OF children being admitted to adult intensive care units more than doubled to 148 cases in 2023, an audit has found.

The authors of the report on service delivery from the country’s two Paediatric Critical Care Units (PCCUs) have stressed that this spike stresses the need for investment to create more regional paediatric high dependency units across Ireland.

The report, published by the National Office of Clinical Audit on the PCCUs in CHI at Crumlin and CHI at Temple Street also found that the bed occupancy rate was above the recommended level of 85% in both hospitals for every month of 2023, with Crumlin having an average occupancy of over 95%, and of 115% in the winter months.

The audit stated that children being admitted to adult ICUs  is “not ideal” for their care and further said that the practice should be avoided “where possible”.

One third of the children who were admitted to adult ICU’s required invasive ventilation, which accounted for 46 cases, while 43 cases were related to sepsis.

31 children aged under one year were admitted to adult ICUs, as well as 41 aged 1-4, 33 aged 5-10, and 43 children ages between 11 and 15 years.

The report did recognise that in some cases (especially those related to respiratory conditions) children are best monitored locally rather than being transferred to PCCUs. 

Another flagged area of concern was out-of-hours discharges, with 14% of children being discharged between 8pm and 7.59 am in 2023. 

This typically happens when there is a shortage of beds available, and in some cases because a direct swap has to happen in order to look after a critically ill child.

Staffing levels remained problematic in both units, with neither achieving the recommended rate of 5.8 whole time equivalent nurses per critical care bed.

Meanwhile admissions to PCCUs rose by 5% compared to 2022, to 1723 total admissions.

The report, which was authored by a team led by Associate Professor Martina Healy, said that an inability to recruit staff, as well as poor retention, and a lack of training to ensure staff can cope with working in such a high stress environment are all contributing factors to the ongoing staffing difficulties in both units.

Temple Street has 9 beds, while Crumlin has 23. The New Children’s Hospital, which is expected to open in 2026, will have 60 beds.

The authors of the report said that staffing issues “need to be addressed” prior to the opening of the New Children’s Hospital.

The audit also stresses the need for the introduction of extracorporeal life support in Ireland.
This is a life-saving treatment for patients with severe heart and lung failure; it involves pumping blood outside the body to a heart-lung machine, which oxygenates the blood and removes carbon dioxide, which aids the healing of the heart and lungs.

It’s often used as a temporary solution for patients awaiting transplants.

From 2019-2023 ten children have been transferred abroad for the treatment. The Audit said that on this basis, there is now a case to be made for introducing the treatment for children in Ireland. It notes that travelling outside of the Republic for their child’s treatment puts an increased strain on families.

The crude mortality rate in both units is still very low. There were 44 deaths in children and infants being treated at the units in 2023.

Overall, the PCCU survival rate in Ireland is 97%.

Half of the deaths occurred in infants aged under one year. Cardiovascular problems was the leading cause of death, followed by respiratory conditions, and neurological problems.

Four children donated solid organs in 2023, meaning that organ donation happened in 9% of cases, which is a higher rate than that in Northern Ireland or England.