Hospital transfers: Children being moved from regional hospitals to specialist care centres are being put at risk, warns a report published today.
The report calls for the establishment of a national seven day/24-hour service to enable critically ill children of all ages to be transferred by road or air from regional hospitals.
Care of the Critically Ill Child in Irish Hospitals, a joint report from the Faculty of Paediatrics of the Royal College of Physicians and the Association of Anaesthetists of Great Britain and Ireland, follows recent controversies surrounding the inter-hospital transfer of new-born babies but it does not deal with cases involving babies born in ambulances.
The report says that children over the age of six weeks are being denied a "paediatric retrieval service". This is the inter-hospital transfer of an ill child from a regional to a more specialised hospital. It points out that this service exists for newborn babies up to the age of six weeks and for adults but that it is not available to older critically-ill children.
The authors state: "Many general anaesthetists are worried that expectations might be too great of the service they can provide to critically-ill children, and on the other hand general paediatricians do not have the skills and ongoing experience to deal with critically ill ventilated children requiring intensive care."
According to Dr Eamon Tierney, consultant anaesthetist at Wexford General Hospital and joint chairman of the working group that produced the report, the basic thrust of the document "is to improve the quality of care available to a critically ill child. It sets out the ground rules for the critical period while a child is being transported by ambulance".
Dr Alan Finan, consultant paediatrician at Cavan Hospital, who also helped draw up the report said: "Any modern health service must have the ability to retrieve patients of all ages from secondary to tertiary care." He said that meningitis, major trauma or a child with severe pneumonia would be typical reasons why a critically-ill child would require urgent transfer.
Both Dr Tierney and Dr Finan emphasised the report's finding that both an experienced anaesthetist and paediatrician should travel with a critically ill child pending the formal establishment of a national hospital transfer service.
However, it is understood that inadequate paediatric cover in a number of smaller hospitals in the State means that this recommendation cannot be implemented at present.
In addition, the lack of intensive care nurses in the paediatric intensive care unit at Our Lady's Hospital for Sick Children, Crumlin, means that, on average, 30 per cent of requests from regional hospitals for the transfer of a critically ill child are turned down.
Fully specialised paediatric intensive care units are only available at two hospitals in the Republic: Crumlin Hospital and Temple Street Hospital in Dublin.
According to the report there are 11 acute general hospitals that do not have paediatricians available to resuscitate a new born infant. They are: Navan, Dundalk, Monaghan, Naas, Nenagh, Mallow, Bantry, Ennis, Roscommon, Tullamore and Cashel.
"It is sub-optimal for doctors or nurses to be required to manage clinical problems in which they are not trained or in which they do not have recent and continuing experience," the report states.