Summary Report
Source: data.gov.uk (2022-01-27)

PICANet Annual Report 2017-2019. Paediatric Intensive Care Audit - This data contains information on all admissions to Paediatric Intensive Care units in the UK and Ireland 2017-2019.

1 
 
 
Summary Report 
Paediatric Intensive Care 
Audit Network 
Annual Report 2020 
Data collection period  
January 2017–December 2019 

2 
PICANet 2020 annual summary report 
Organisation key 
A 
Addenbrooke’s Hospital, Cambridge 
C 
Noah’s Ark Children’s Hospital for Wales, Cardiff 
D 
Royal Manchester Children’s Hospital 
E1 
Great Ormond Street Hospital, London (PICU/NICU) 
E2 
Great Ormond Street Hospital, London (CICU) 
F 
Evelina London Children’s Hospital 
H 
King’s College Hospital, London 
I 
Leeds General Infirmary 
K2 
Freeman Hospital, Newcastle upon Tyne 
K3 
Great North Children’s Hospital, Newcastle upon Tyne 
L 
Royal Stoke University Hospital 
M 
Nottingham Children’s Hospital, Queens Medical Centre, Nottingham 
N 
John Radcliffe Hospital, Oxford 
O 
Royal Brompton Hospital, London 
P 
Alder Hey Children’s Hospital, Liverpool 
Q 
Sheffield Children’s Hospital 
R 
Southampton Children’s Hospital 
S 
James Cook University Hospital, Middlesbrough 
T 
St George’s Hospital, London 
U 
St Mary’s Hospital, London 
V 
Birmingham Children’s Hospital 
W 
Bristol Royal Hospital for Children 
X1 
Glenfield Hospital, Leicester 
X2 
Leicester Royal Infirmary 
Y 
Royal Hospital for Sick Children, Edinburgh 
Z 
The Royal London Hospital 
ZA 
Royal Hospital for Children, Glasgow 
ZB 
Royal Belfast Hospital for Sick Children 
ZC 
Children’s Health Ireland at Crumlin, Dublin (formerly Our Lady’s Children’s Hospital, Crumlin) 
ZD 
Children’s Health Ireland at Temple Street, Dublin (formerly Temple Street Children’s University Hospital) 
ZE 
Harley Street Clinic, London 
ZF 
The Portland Hospital, London 
T001 
Children’s Acute Transport Service (CATS) 
T002 
Embrace: Yorkshire & Humber Infant & Children’s Transport Service 
T003 
North West and North Wales Paediatric Transport Service (NWTS) 
T004 
South Thames Retrieval Service (STRS) 
T005 
KIDS Intensive Care and Decision Support 
T008 
Southampton Oxford Retrieval Team (SORT) 
T010 
Northern Ireland Specialist Transport and Retrieval (NISTAR) Paediatric 
T020 
Scotland Specialist Transport and Retrieval (ScotSTAR) 
T022 
Irish Paediatric Acute Transport Service (IPATS) 
T024 
Wales and West Acute Transport for Children (WATCh) 
T026 
North East Children’s Transport and Retrieval Service (NECTAR) 
T027 
Children’s Medical Emergency Transport Service (CoMET) 
T028 
Heartlink ECMO Children’s Service 
Published in the UK by the Paediatric Intensive Care Audit Network (PICANet). This work is copyright. Apart from 
any use as permitted under the Copyright, Designs and Patents Act 1988, no part may be reproduced by any 
process without permission from PICANet. 
Requests and enquiries concerning reproduction rights should be directed to PICANet at: 
PICANet, School of Medicine, University of Leeds, Clarendon Way, Leeds, LS2 9JT 
Telephone xx-xxxx-xxxx  Email xxx@xxx.xx 
In all cases, PICANet must be acknowledged as the source when reproducing or quoting any part of this 
publication. Please use the following format when citing this report: Paediatric Intensive Care Audit Network 
Annual Report 2020 (published February 2021): Universities of Leeds and Leicester 
For this report content is © 2021 University of Leeds, University of Leicester and the Healthcare Quality 
Improvement Partnership.  
 
The ISBN number for this publication is 978-0-85316-362-6. 

 
3 
  
Contents 
Acknowledgements ................................................................................................................ 5 
Introduction ............................................................................................................................ 7 
Key findings ........................................................................................................................... 8 
Recommendations ............................................................................................................... 11 
How we present our results .................................................................................................. 13 
Headline figures: Admission numbers and bed days ............................................................ 14 
Headline figures: Admission rates by country of residence .................................................. 18 
Headline figures: Death in PICU .......................................................................................... 20 
Headline figures: Unplanned extubation............................................................................... 22 
Headline figures: Referral for transport ................................................................................ 24 
Headline figures: Bed occupancy during ‘normal hours’ and ‘out of hours’ ........................... 26 
Metric 1: Case ascertainment and timeliness of data submission ......................................... 30 
Metric 2: Retrieval mobilisation times ................................................................................... 36 
Metric 3: Number of nurses providing clinical care per bed .................................................. 40 
Metric 4: Emergency readmissions within 48 hours.............................................................. 42 
Metric 5: Mortality in PICU ................................................................................................... 46 
References .......................................................................................................................... 49 
Additional information .......................................................................................................... 51 
 
For the Tables, Figures and Appendices relating to this report, please visit the PICANet 
website www.picanet.org.uk. 
 
 


Acknowledgements 
5 
Acknowledgements 
The Paediatric Intensive Care Audit Network (PICANet) gathers information on all patients 
admitted to paediatric intensive care units (PICUs) in the UK and Republic of Ireland, in 
conjunction with centralised transport services (CTS). 
We are indebted to the efforts of all the audit clerks, secretaries, nurses and doctors who 
support and contribute to PICANet from their own PICUs and CTS. We are particularly 
grateful for everyone’s support and contributions this year despite the significant challenges 
of the Covid-19 pandemic over the past 12 months. 
PICANet also continues to rely on the expertise and support from the Paediatric Critical Care 
Society (PCCS), the PICANet Steering Group and members of the Clinical Advisory Group 
who provide an essential link between PICANet and the clinical care teams. We would like to 
acknowledge this support, which enables the PICANet audit to continue to be a success. 
The PICANet Audit is commissioned by the Healthcare Quality Improvement Partnership 
(HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP), 
the Welsh Health Specialised Services, NHS Lothian/National Services Division NHS 
Scotland, the Royal Belfast Hospital for Sick Children, The National Office of Clinical Audit 
(NOCA) for the Republic of Ireland and HCA Healthcare UK. HQIP is led by a consortium of 
the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. 
Its aim is to promote quality improvement in patient outcomes, and in particular, to increase 
the impact that clinical audit, outcome review programmes and registries have on healthcare 
quality in England and Wales. HQIP holds the contract to commission, manage and develop 
the NCAPOP, comprising around 40 projects covering care provided to people with a wide 
range of medical, surgical and mental health conditions. The programme is funded by NHS 
England, the Welsh Government and, with some individual projects, other devolved 
administrations and crown dependencies. 
http://www.hqip.org.uk/national-programmes 
 


Introduction 
7 
Introduction 
This is the seventeenth annual PICANet clinical audit report documenting paediatric critical 
care activity which occurred in the United Kingdom (UK) and Republic of Ireland (ROI) 
between 2017 and 2019. This report forms part of PICANet’s contracted obligations, 
providing key information to monitor the delivery and quality of care in relation to agreed 
standards and evaluate clinical outcomes to inform national policy in paediatric critical care. 
Information on five key metrics related to Paediatric Intensive Care services is provided: case 
ascertainment including timeliness of data submission, retrieval mobilisation times, number 
of qualified nurses per bed, emergency readmissions within 48 hours and mortality in PICU. 
Whilst outlier analysis is only mandated for mortality, PICANet provides an additional 
monitoring function for mortality within each unit through the availability of real-time ‘RSPRT’ 
plots. We encourage units to continue to use this functionality to monitor performance. 
Although this Summary Report offers an overview of the key findings and recommendations, 
readers are guided to the full set of tables and figures which have been released 
simultaneously and comprehensively describe admissions, referrals and transport activity 
within PICUs over the last three years. Individual tables and figures can be downloaded in 
electronic form from the main PICANet website www.picanet.org.uk. 
We also remain committed to the continued development of the PICANet web platform and 
underlying database to enhance the user experience and to ensure that all key performance 
data for units can be visualised through an online dashboard. 
 
Professor Liz Draper 
Dr Richard Feltbower, 
Principal Investigators 
 
 

8 
PICANet 2020 annual summary report 
Key findings 
▪ 
The number of admissions per year to paediatric intensive care across the UK and 
Republic of Ireland showed a slow and steady increase over the period 2017–2019 
from 19,869 to 20,383. This increase was mainly driven by a 22% increase in 
admissions in Scotland between 2017 (n=1390) and 2019 (n=xx-xxxx-xxxx) and a small 
increase in English NHS units and in the Republic of Ireland. Numbers of admissions 
in Wales and Northern Ireland remained steady. 
▪ 
Units across the UK and ROI delivered on average around 142,000 bed days per 
year between 2017–2019. There was a steady increase in bed days over the period 
specifically in Wales, Scotland and the ROI. 
▪ 
Admission rates to paediatric intensive care varied by country, ranging from 132 per 
100,000 children in the Republic of Ireland to rates of 165 and 168 in Northern Ireland 
and Scotland, respectively. 
▪ 
The likelihood of dying whilst being treated within PICUs was very low throughout the 
three-year period, with 96.5% of admissions discharged alive. Deaths within PICU 
comprise around one in every six of all children’s deaths in the UK and one in every 
five in the ROI. 
▪ 
Annual rates of reported unplanned extubation varied between 3.7 and 5.0 for every 
1,000 days of invasive ventilation throughout the reporting period. Two fifths of all 
units reported a decrease in the number of unplanned extubations over the three 
years 2017 to 2019. 
▪ 
Over the period 2017 to 2019 specialist PIC transport services accepted 16,623 
(92.3%) of referrals for urgent transfer to PIC. Rates of refusal ranged from 0% to 
12.8% for those transport teams providing a 24 hour service. 
▪ 
Once again, reported rates of bed occupancy remain high in PICUs. During the 
PICANet staffing census week intensive care bed occupancy rates were 100% in 
Scotland and over 80% in England (NHS), Wales, Northern Ireland and the Republic 
of Ireland. High dependency bed occupancy ‘in normal hours’ was reported at 86% in 
England (NHS) and lower rates were reported in the devolved nations and the 
Republic of Ireland. ‘Out of hours’ bed occupancy was similarly high with reported 
rates of 100% Intensive Care (IC) bed occupancy for Scotland, above 90% for 
Northern Ireland and the Republic of Ireland and around 80% for Wales and England 
(NHS). For high dependency (HD) care ‘out of hours’ bed occupancy was reported as 
over 75% for England and Wales. Lower rates were reported for the other devolved 
nations and the Republic of Ireland. 
▪ 
At least 95% of admissions reported to PICANet from nine PICUs in 2019 were 
confirmed after a validation exercise was undertaken, with six of these units reporting 
more than 99% of cases. 
▪ 
85% of units across the UK and Republic of Ireland (excluding Northern Ireland) 
provided complete and timely admissions’ data to PICANet within three months of 
discharge. Nine units achieved completeness within three months for at least 98% of 
their admissions. One unit completed fewer than 50% of their admission records 
within this timescale. 
▪ 
Of the 4,245 journeys carried out for children requiring urgent transport to a PICU, 
just under three fifths (58.8%) were started within 30 minutes and three quarters 
(76.5%) started within one hour of the decision being made. Just over 1 in 20 
journeys (6.3%) started more than three hours after this decision. 

Key findings 
9 
▪ 
One quarter of PICUs (25%) met the PICS standard for nursing staff of 7.01 WTEs 
(whole time equivalents) when all staff providing clinical care (including non-
registered health care staff: Bands 2–4) are included. However, if recorded vacancies 
were filled to unit nurse establishment figures half of PICUs (48%) would meet this 
standard. Nevertheless, as in previous years, the annual PICANet census shows that 
units ensure their staffing levels are appropriate for the number of children on the unit 
and their care requirements. 
▪ 
Overall rates of emergency readmission within 48 hours of discharge remained the 
same across the reporting period, at around 1.7%. However, these ranged from 1.6% 
in England and the Republic of Ireland to 2.1% in Northern Ireland. 
▪ 
No negative statistical outliers were identified for mortality rates for any unit between 
2017 and 2019. 
 
 


Recommendations 
11 
Recommendations 
 
 
 
 
 
1. Monitor bed occupancy levels in close liaison with commissioners and Operational 
Delivery Networks (ODNs) to ensure adequate critical care beds are available to meet 
demand.  
Action: Paediatric Intensive Care Units (PICUs), commissioners and ODNs. 
2. Review the timeliness and quality of their submission of data to PICANet, to ensure 
compliance with the PICS standards.  
Action: PICUs and Paediatric Intensive Care (PIC) Centralised Transport Services. 
3. Investigate events where their retrieval mobilisation times do not meet the 30-minute 
NHS England target and develop a strategy to ensure optimal compliance. 
Action: PIC Centralised Transport Service teams. 
4. Ensure adequate staff availability for the PIC Centralised Transport Service by reviewing 
PICANet data with commissioners. 
Action: PIC Centralised Transport Service teams and commissioners. 
5. Review and improve national recruitment and retention initiatives of PIC nurses and the 
use of non-registered health care staff to support qualified nurses in delivering clinical 
care, to ensure that all PICUs have appropriate staffing levels. 
Action: national nursing professional bodies, NHS Trusts and Health Boards and Health 
Education bodies in the UK and RoI. 
6. Ensure that the data collected to monitor unplanned extubation rates complies with the 
agreed PICANet definition. PICUs with the lowest rates of unplanned extubations should 
be encouraged to share examples of best practice to reduce variation between units. 
Action: PICUs. 
7. Work should be carried out to develop a more robust risk-adjustment score for in-PICU 
mortality. 
Action: Paediatric Critical Care Society-Study Group, PICU clinicians. 


How we present our results 
13 
How we present our results 
Results are presented in tables and figures. In general, data are presented for children aged 
0–15 years, however data are also presented in separate tables for patients who are 16 
years and older and treated on PICU. Each specific measure of interest is explained in the 
results and metrics sections of this report under the heading “What are we measuring?” 
We look at a wide range of measures including the number of admissions, how many days 
patients are in PICU, the types of treatments patients receive and clinical outcomes such as 
death. We present data according to age, sex, country of admission, treating PICU as well as 
country of residence and where the child is living. 
Rates 
We present certain information in the form of rates, enabling comparisons to be made 
between countries even though the population size in each country is different. Rates are 
usually presented as the number per 1,000 or per 100,000 of the relevant population. 
When we want to compare two rates we divide one rate by the other, to get a relative rate. 
For example, if we wanted to compare the admission rate in Scotland to that in England then 
we would divide the Scottish admission rate by the English admission rate. If the two rates 
were the same then the relative rate would be one. If the Scottish rate was higher than the 
English rate then the relative rate would be greater than one. If the Scottish rate was lower 
than the English rate then the relative rate would be less than one. This measure allows us to 
talk about the Scottish rate in comparison (or relative) to the English rate. 
Deaths 
We measure how poorly children were at the point when they were admitted to PICU using 
the Paediatric Index of Mortality 3 (PIM3)3. This takes into account many factors (such as 
whether the child was admitted as an emergency and whether they needed help breathing) 
to estimate how likely each child is of dying. 
When comparing deaths in PICU, we calculate the risk-adjusted standardised mortality ratio 
(SMR). This compares the number of deaths that have happened in a PICU and how many 
deaths we expected to happen given how poorly children were when they were admitted to 
PICU. We also use ‘funnel plots’ to compare individual PICUs in terms of mortality which is a 
way of displaying and comparing the risk-adjusted SMR on the same graph. These plots tell 
us what range of values we might expect to see for the SMR in each PICU, given that we 
expect a certain amount of variation as these calculations are based on a very small number 
of deaths. Further details on funnel plots and how to interpret them are provided in the 
“Metric 5: Mortality in PICU” section. 
 
 

14 
PICANet 2020 annual summary report 
Headline figures: Admission numbers and 
bed days 
What are we measuring? 
Table 1 and Figure 1 below summarise the number of admissions to paediatric intensive 
care units in the UK and Republic of Ireland between 2017 and 2019 among children aged 
under 16 years at the time of admission. Table 2 and Figure 2 summarise the number of 
bed days of paediatric intensive care that were delivered during this period. 
What did we find? 
There were approximately 20,000 admissions to PICUs every year between 2017 and 2019 
across the UK and Republic of Ireland. The number of admissions per year increased slightly 
year on year, reaching a peak of around 20,400 in 2019. The number of admissions to non-
NHS PICUs in England decreased over the reporting period from a peak of over 500 
admissions in 2017 to around 300 admissions in 2019. There was also a small but steady 
reduction in admissions in Northern Ireland, from over 520 in 2017 to just over 490 in 2019. 
The number of admissions in Scotland increased in 2019 from around 1,400 admissions per 
year in 2017 and 2018 to approximately 1,700 admissions. 
The number of bed days delivered ranged from around 140,000 to 144,000. Whilst the 
number of admissions to non-NHS PICUs in England decreased over the reporting period, 
the equivalent number of bed days rose reaching approximately 3,300 in 2019. The 
increased number of admissions in Scotland in 2019 was mirrored by an increase in the 
number of bed days delivered. A steady increase in bed days was also observed in the 
Republic of Ireland over the three-year period. 
Table 1: Number of admissions by country of PICU and year 
Country of admission 
2017 
2018 
2019 
England (NHS) 
15,475 
16,029 
15,888 
England (non-NHS) 
526 
351 
303 
Wales 
493 
510 
489 
Scotland 
1,390 
1,351 
1,697 
Northern Ireland 
522 
501 
492 
Republic of Ireland 
1,463 
1,430 
1,514 
Total 
19,869 
20,172 
20,383 
N.B. This table does not include admissions where the child’s age is unknown or those aged 16+ years at 
admission. 

Headline figures: Admission numbers and bed days 
15 
 
Figure 1: Number of admissions to PICU by country of admission and year 
 
Table 2: Number of bed days delivered by country of admission and year 
Country of admission 
2017 
2018 
2019 
England (NHS) 
110,067 
114,720 
111,757 
England (non-NHS) 
2,829 
2,695 
3,281 
Wales 
2,451 
2,509 
2,626 
Scotland 
10,765 
10,319 
12,054 
Northern Ireland 
3,695 
3,282 
3,422 
Republic of Ireland 
9,607 
10,177 
10,393 
Total 
139,414 
143,702 
143,533 
N.B. This table does not include admissions where the child’s age is unknown or those aged 16+ years at 
admission. 
 

16 
PICANet 2020 annual summary report 
Figure 2: Number of bed days delivered by country of admission and year 
 
What does this mean? 
Paediatric intensive care services continue to experience high demand across the UK and 
Republic of Ireland; this is reflected in an average of over 55 new admission events per day. 
The number of admissions increased slightly year on year, and the increase in bed days 
delivered between 2017 and 2018 was sustained into 2019. These apparent changes in 
trends over the reporting period illustrate the requirement to closely monitor PICU demand 
not only in terms of admission burden but equally for the number of bed days provided to 
ensure sufficient care provision is available. 
 
 
 
 

Headline figures: Admission numbers and bed days 
17 
Further details 
Definitions and methods 
Every admission to a PICU in the UK and the Republic of Ireland is counted for each year, 
2017–2019. If a child has been readmitted during that period this will be counted as a 
separate admission. A ‘bed day’ is counted if a child is in a PICU bed for a day or part of a 
day which occurs within the reporting period (i.e. between 1 January 2017 and 31 December 
2019). 
We have only provided figures for children less than 16 years old (the normal age limit for 
admission to PICU). All designated PICUs across the UK and ROI provided data to PICANet 
including the two private providers of PIC based in England up to the end of 2019. 
Why is this important? 
The number of admissions and the number of bed days tell us how busy the PICUs are and 
helps the commissioners, who provide funding for paediatric intensive care, to work out how 
many staff and beds are required to meet the demand. This is important, as too few beds 
might mean that a child may not receive intensive care when they need it, or there may be a 
delay. Although it is unlikely, if the commissioners overestimate demand, it is possible that 
staff and beds would be under-utilised, which would be a waste of resources. 
The data regarding PICU admissions and bed days delivered have been used by the recent 
Paediatric Critical Care Review for England1. 
 
 

18 
PICANet 2020 annual summary report 
Headline figures: Admission rates by 
country of residence 
What are we measuring? 
Annual rates of admissions to PICU between 2017 and 2019 are presented in Table 3 by 
country of residence, calculated per 100,000 children in the population. This identifies what 
proportion of the childhood population are treated by paediatric intensive care services in 
each country every year.  
What did we find? 
PICU admission rates were highest in Scotland, reaching 168 admissions for every 100,000 
children, followed by Northern Ireland (164), England (140), Wales (139), and the Republic of 
Ireland (132). For the UK and Republic of Ireland combined, admissions rates were 142 per 
100,000 population per year.  
Admissions rates in Northern Ireland decreased over the reporting period from 169 to 159.  
In 2019, the admission rates in Scotland increased to 190. Rates in the Republic of Ireland, 
Wales and England remained steady across the three-year period. 
Table 3: Rate of admissions per 100,000 childhood population, 2017-2019 
Country of admission 
2017 
2018 
2019 
2017-2019 
England 
137.3 
141.3 
141.3 
140.0 
Wales 
139.1 
138.8 
139.4 
139.1 
Scotland 
160.9 
152.9 
190.1 
xx-xxxx-xxxx 
Northern Ireland 
xx-xxxx-xxxx 
166.4 
159.0 
xx-xxxx-xxxx 
Republic of Ireland 
131.8 
129.8 
135.5 
132.4 
Total 
139.4 
141.8 
144.5 
141.9 
Based on country of residence. 
What does this mean? 
There was substantial geographical variation in admissions rates to PICU between countries, 
comprising essential information required for the planning of national PIC services. Possible 
explanations for these findings could involve differences in admission policies between each 
country, the availability of specialised critical care and transport services at the time of 
admission, and distance to the nearest PICUs. 
Further details 
Definitions and methods 
For each of the UK countries and the Republic of Ireland, the number of admissions was 
divided by the number of children in the population; this number was multiplied by 100,000 to 
give the number of admissions per 100,000 children aged under 16 to give the admission 
rate. We used national census data to estimate the childhood population in each country. 

Headline figures: Admission rates by country of residence 
19 
Why is this important?  
It is important for each country participating in PICANet to know the rate of admission to 
paediatric intensive care to allow them to plan services effectively. The variation in admission 
rates could be investigated to understand if these are real geographical differences (e.g. 
proximity to PICU, level of urbanicity) or explained by differences in clinical practise or 
commissioning in the populations for each nation. 
 
 

20 
PICANet 2020 annual summary report 
Headline figures: Death in PICU 
What are we measuring? 
All deaths that occur after admission but prior to discharge from PICU are recorded and 
reported here for children under 16 who were admitted between 2017 and 2019. Deaths are 
presented based on the country of admission (i.e. PICU location) as deaths must be 
registered in the country where the person died.  
What did we find? 
Table 4 summarises the number of deaths in PICU by country of admission and year. The 
percentages were calculated for each country based on the total number of admissions for 
that year. There was a total of 2,104 deaths over the three year period, equivalent to 965 
children out of every 1,000 being discharged alive.  
 
Table 5 shows the proportion of deaths in PICU, compared to all childhood deaths in the UK 
and Republic of Ireland. For context, we also present the total number of deaths in the 
population in brackets. For children admitted in the UK, PICU deaths accounted for between 
15–16% of the total number of children’s deaths. For children admitted in the Republic of 
Ireland, PICU deaths accounted for between 21–22% of the total number of children’s 
deaths. 
Table 4: Proportion of deaths in PICU of all PICU admissions, by country of 
admission and year 
Country of admission 
2017 
2018 
2019 
2017-2019 
England 
3.8% (n=604) 
3.4% (n=562) 
3.6% (n=575) 
3.6% (n=1,741) 
Wales 
2.0% (n=10) 
4.3% (n=22) 
2.0% (n=10) 
2.8% (n=42) 
Scotland 
2.5% (n=35) 
2.4% (n=33) 
1.9% (n=33) 
2.3% (n=101) 
Northern Ireland 
3.4% (n=18) 
2.4% (n=12) 
2.3% (n=11) 
3.0% (n=41) 
Republic of Ireland 
4.1% (n=60) 
4.1% (n=59) 
4.0% (n=60) 
4.1% (n=179) 
Total 
3.7% (n=727) 
3.4% (n=688) 
3.4% (n=689) 
3.5% (n=2,104) 
Data are presented based on date of admission 
Due to small numbers, data for non-NHS and NHS organisations in England are presented combined. 
Table 5: Proportion of deaths in PICUs of all children’s deaths in the population: 
UK and Republic of Ireland, 2017–2019 
Country of admission 
2017 
2018 
2019 
UK 
16.1% (n=667) 
15.6% (n=629) 
15.9% (n=629)** 
Republic of Ireland 
22.0% (n=60) 
21.1% (n=59)* 
22.1% (n=60)* 
Based on country of admission 
* The numbers of total deaths for the Republic of Ireland for 2018 and 2019 is currently provisional and subject 
to change. 
** The number of total deaths for Northern Ireland for 2019 is provisional and subject to change. 
 

Headline figures: Death in PICU 
21 
What does this mean? 
Risk of death in paediatric intensive care is low with 96.5% of patients being discharged alive 
between 2017 and 2019. Deaths in PICU account for about one in every six of all children’s 
deaths in the UK and about one in every five children’s deaths in the Republic of Ireland in 
any given year. 
Further details 
Definitions and methods 
We have recorded the number of deaths in PIC by year and by country of admission for 2017 
to 2019. The percentages in Table 4 are based on the number of admissions to PICUs over 
this period, not the number of individual children (i.e. if the same child had two admissions in 
the same time period, this would count as two admissions). In Table 5, we present deaths on 
PICUs (2017–2019) as a proportion of all child deaths (0–15 years) in the UK and the 
Republic of Ireland. 
Why is this important? 
Death on PICU is rare and the rate of PICU death has fallen steadily since PICANet started 
collecting data in 2002. It is important to record the number of deaths to facilitate the 
investigation of mortality trends over time. It also highlights any differences in death rates 
between countries. Where there are very small numbers of deaths, caution should be applied 
when making comparisons as apparently large differences may happen by chance. 
 
 

22 
PICANet 2020 annual summary report 
Headline figures: Unplanned extubation 
What are we measuring? 
Children who need help with their breathing may require a tube placed in their throat 
connected to a machine: this is called invasive ventilation. If the tube is accidentally 
dislodged, this is referred to as unplanned extubation. In Figure 3 and Table 6, we present 
the number of unplanned extubations for every thousand days of invasive ventilation that 
were reported based on country of admission. Figure 3 shows the rate of unplanned 
extubation by organisation for each year of the reporting period, ranked by the 2019 rate. 
What did we find? 
The number of unplanned extubations in the UK (excluding Wales) and Republic of Ireland in 
2017 was 254 and in 2018 was 339 out of a total of over 67,000 days of invasive ventilation 
provided in each year. In 2019, this decreased to 306 unplanned extubations out of a total of 
just over 66,000 days of invasive ventilation. These figures equate to unplanned extubation 
rates of 3.7 (95% confidence interval (CI): 3.3 – 4.2), 5.0 (95% CI: 4.5 – 5.6) and 4.6 (95% 
CI: 4.1 – 5.2) unplanned extubations for every 1,000 days of invasive ventilation for 2017, 
2018 and 2019 respectively. 
Eighteen PICUs demonstrated a decrease in their unplanned extubation rate between 2018 
and 2019, and 12 units had an increase in rate. 
There were two units for which there were no unplanned extubation events reported in either 
2017, 2018 or 2019. Two further units reported no unplanned extubations in 2017 or 2018 
but did report at least one event in 2019. It is important to understand the reasons for these 
observations in terms of whether this reflects high performing units or differing standards of 
data reporting. 
Figure 3: Unplanned extubation rates per 1,000 days of invasive ventilation by 
health organisation, 2017 -2019 
 
Ranked by unplanned extubations rate for 2019 

Headline figures: Unplanned extubation 
23 
Table 6: Rate of unplanned extubation per 1,000 days of invasive ventilation by 
country of admission 
 
2017 
2018 
2019 
2017-2019 
England (NHS) 
3.6 (n=206) 
5.1 (n=287) 
4.5 (n=248) 
4.4 (n=741) 
Wales 
 
 
 
2.3 (n=8) 
Scotland 
4.8 (n=20) 
6.0 (n=24) 
6.0 (n=25) 
5.6 (n=69) 
Northern Ireland 
3.2 (n=5) 
2.8 (n=4) 
6.5 (n=9) 
4.1 (n=18) 
Republic of Ireland 
4.0 (n=20) 
3.8 (n=21) 
4.2 (n=24) 
4.0 (n=65) 
Total 
3.7 (n=251) 
5.0 (n=336) 
4.6 (n=306) 
4.4 (n=901) 
Data are presented based on date of unplanned extubation 
Due to small numbers, data for non-NHS and NHS organisations in England are presented combined and data for 
Wales are presented for the whole reporting period combined only. 
 
What does this mean? 
Unplanned extubation remains a relatively rare event within paediatric intensive care 
services with a recorded annual rate of between four and five per 1,000 days of invasive 
ventilation on average in 2017–2019. All units reported unplanned extubation rates below 
eight per 1,000 intubated days in 2019. However, this is still a relatively new data item, as 
units have only recently been required to report and quality assure this metric. Changes in 
rates of unplanned extubation should therefore be carefully monitored over the next few 
years. 
Further details 
Definitions and methods 
When a child is intubated and ventilated it means that they have a tube placed in their throat 
attached to a machine that helps them to breathe. The machine can be used to provide 
different levels of oxygen to help their recovery. If the tube is accidentally removed, this is 
called an unplanned extubation. As we are comparing such events between PICUs, we need 
to calculate a rate of unplanned extubation, based on how many days of invasive ventilation 
are provided in each PICU, as the more patients that are ventilated on a PICU, the more 
likely an unplanned extubation will occur. To calculate the rate, we take the number of 
unplanned extubations for every 1,000 invasive ventilation days delivered. This makes 
comparisons between units with different volumes of invasive ventilation possible. Unplanned 
extubation is referred to as an ‘adverse event’.  
Why is this important? 
Unplanned extubation is the most common adverse event related to airway management in 
intensive care: it can cause complications such as hypoxaemia (very low blood oxygen), 
hypercarbia (high blood carbon dioxide) and sometimes, but very rarely, death2. Clearly, it is 
best to avoid unplanned extubation, if at all possible, but there are no established guideline 
levels: the NHS England service specification notes the threshold is still to be agreed3. 
Kanthimathinathan and colleagues referred to a notional threshold equivalent to 10/1000 
days2. By continuously monitoring unplanned extubation rates, it may be possible to detect 
when a change in practice occurred, such as the change in the adhesive tapes that caused 
an increase in unplanned extubation rates noted by Kanthimathinathan and colleagues2. 
 

24 
PICANet 2020 annual summary report 
Headline figures: Referral for transport 
What are we measuring? 
If a child needs specialist paediatric intensive care (PIC) transport, a referral is made to the 
PIC transport team. Sometimes the initial referral may not result in a transport, and this is 
called a refusal. We have recorded the number of referrals during the period 2017–2019, the 
number which were successful and the number which were refused. We have also looked at 
the reason why they were refused. 
What did we find? 
Over the three years 2017–2019, the details of 18,349 referrals for PIC transport where 
clinicians agreed that PIC transport was required. The number of these referrals by PIC 
Central Transport Service (CTS) is presented by the grey bars on Figure 4. Of these, 92.1% 
(16,893) were accepted for transport by one of the twelve commissioned specialist paediatric 
intensive care (PIC) transport teams in the UK and Republic of Ireland. Around 1 in 13 
(1,456) were not accepted for transport. The proportion of referrals refused for transport 
varied from 0% to 28.5% per PIC CTS – this is shown ranked by refusal rate by the orange 
circles on the figure. Four CTS organisations (T002, T005, T022 and T026) reported less 
than a 2% refusal rate, one of which provides a service for a devolved nation. T010 that 
reported a 28.5% refusal rate (reduced from 34% the previous year) endeavour to provide a 
24 hour service but this is often limited by staff availability. 
Reasons for refusal include: no PIC transport team being available; the condition of the child 
being assessed as time critical and therefore the transport of the child could be delivered 
appropriately by another team; or as being ‘out of scope of care’, for example a neonatal 
transfer team who provide transport for small babies could more appropriately provide care.  
Figure 4: Refusals following referral for urgent paediatric intensive care 
transport: UK and Republic of Ireland 2017-2019 
 
T027 was established in March 2017 

Headline figures: Referral for transport 
25 
What does this mean? 
When a transport team receives a referral, and the specialist PIC doctor agrees that the child 
requires transfer from the original admitting hospital to a PICU in another hospital, they also 
need to confirm that the PICU has a bed available to care for the child. If a bed is not 
available at the nearest PICU, the PIC transport team will seek an available bed in an 
alternative PICU. Over the period 2017–2019, the specialist PIC transport service were able 
to provide a response to over 92% of requests for transport. 
When the transport team refuse the referral because they are already busy with other 
transfers, urgent referrals may be passed to another PIC transport team, or the child may 
remain at the local hospital with ongoing provision of support and advice about treatment 
being provided by the specialist PIC transport doctor, until a staffed transport team is 
available. 
PIC transport may also be provided for children who are transferred from one PICU to 
another, to another specialist service, a hospice or home. 
All children requiring PIC transport (agreed by the PIC specialist doctor) will be cared for and 
transferred by a PIC transport service or another transport provider. 
Further details 
Definitions and methods 
We have recorded how many children have a referral for a specialist PIC transport team to 
collect them and transfer them to a PICU. Where the transport does not happen, PICANet 
record the reasons given by the transport teams. T028 is an ECMO transport team, not a 
commissioned specialist PIC transport team and therefore excluded from this headline figure. 
Why is this important? 
Although only a small proportion of referrals were not accepted for urgent transfer to PIC it is 
important to investigate the reason for any refusals. Almost half of refusals were due to the 
lack of availability of a PIC team. These requests may be passed to another PIC specialist 
transport team or the child may remain in the care of their local hospital under close 
supervision from the PIC team until transport can be mobilised. However this may result in 
the child being moved to a PICU in another part of the country. 
Delays in receiving intensive care may have clinical implications and can cause stress for the 
patients and their carers. 
Sometimes the PIC transport team advise that the local hospital transfer the child themselves 
to urgently access specialist treatment e.g. a child with a serious head injury. This is 
recorded by PICANet as a time critical transfer. In cases where the PIC transport team 
assess that the specialist transport required is out of their scope of care, the transport is 
provided by another specialist transport team (e.g. a neonatal team providing transport for an 
extremely preterm infant). For some teams the ability to respond to an urgent referral ‘out of 
hours’ may at times be limited by staff availability. 
The ability of a PIC transport team to transfer a child to a PICU also depends on there being 
a PIC bed available. 
 
 

26 
PICANet 2020 annual summary report 
Headline figures: Bed occupancy during 
‘normal hours’ and ‘out of hours’ 
What are we measuring? 
The annual staffing study for PICANet collects information about the number of open beds in 
PICUs that were occupied at midday on a weekday and a weekend day, during the week 
beginning 11 November 2019 in the UK and Republic of Ireland. The number of open beds is 
the number of intensive care (IC) and high dependency (HD) beds on a PICU for whom staff 
were available. 
What did we find? 
At the ‘normal hours’ census point (midday Wednesday) in 2019, 100% of IC beds were 
occupied in Scotland and over 80% in England (NHS), Wales, Northern Ireland and, the 
Republic of Ireland (Figure 5). HD bed occupancy ‘in normal hours’ was reported at 86% in 
England (NHS), although lower numbers were reported in Wales, Scotland and the Republic 
of Ireland. 
At the ‘out of hours’ census point at midday on a Sunday 100% IC bed occupancy was again 
reported for Scotland, whilst Northern Ireland and the Republic of Ireland (NHS) were above 
90%, Wales at 83% and England at 78%. ‘Out of hours’ bed occupancy for HD care was 
reported as over 75% for England (NHS) and Wales, with lower numbers reported for 
Scotland and the Republic of Ireland. 
Figure 5: Percentage of funded critical care beds occupied at midday 
Wednesday and midday Sunday in November, 2019 
 
Number of funded beds reported in the appendices 
 
85% bed occupancy
0
25
50
75
100%
England
(NHS)
England
(non-NHS)
Wales
Scotland Northern
Ireland
Republic
of Ireland
England
(NHS)
England
(non-NHS)
Wales
Scotland Northern
Ireland
Republic
of Ireland
Midday Wednesday
Midday Sunday
Funded beds 
occupied
Intensive care
High dependency

Headline figures: Bed occupancy during ‘normal hours’ and ‘out of hours’ 
27 
Figure 6: Percentage of funded critical care beds occupied at midday 
Wednesday and midday Sunday in November, 2017–2019 
 
Number of funded beds reported in the appendices 
What does this mean? 
Across the UK reported bed occupancy rates in PIC remain high both during ‘normal hours’ 
and ‘out of hours’. This reflects the ongoing steady increase in activity in PICUs observed 
since the start of PICANet in 2002–2003.  
The number of funded IC beds reported to PICANet has remained consistent over the 
previous three years in England (NHS), Wales, Northern Ireland and the Republic of Ireland; 
in Scotland a small reduction (10%) is reported. For HD level beds housed within a PICU the 
number of reported beds has increased in England (NHS) and England (non-NHS) due to 
changes in designation of funded beds or reporting in a small number of units over the three 
years 2017–2019. 
Overall occupancy of IC beds, recorded as a snapshot in November each year shows high 
variation; in England (NHS) Figure 6 shows a small reduction from 93% in 2017 to 80% in 
2019 and in Scotland IC bed occupancy is above 85% in all three years. This may be a 
limitation of data collection at ‘census’ time points’; or may indicate a change in provision of 
critical care or changing practice. 
Further details 
Definition and methods 
Information about bed occupancy is collected each year as part of the PICANet staffing 
study. The survey collects details about the total number of open and funded (commissioned) 
intensive care and high dependency care beds, and the number of actual children being 
cared for on each PICU by the level of care requirement for four ‘snapshot’ time periods: a 
weekday; and weekend; at noon and midnight. The proportion of open and funded beds 
occupied during ‘normal hours’ (Wednesday at noon) and ‘out of hours’ (Wednesday at 
midnight, Sunday at midday and Sunday at midnight) are then calculated. In Figure 5 we 
present the data for midday on a Wednesday and Sunday and in Figure 6 we compare this 
data for a three year period 2017–2018. 
85% bed occupancy
0
25
50
75
100%
2017
2018
2019
2017
2018
2019
2017
2018
2019
2017
2018
2019
2017
2018
2019
2017
2018
2019
2017
2018
2019
2017
2018
2019
2017
2018
2019
2017
2018
2019
2017
2018
2019
2017
2018
2019
England
(NHS)
England
(non-NHS)
Wales
Scotland
Northern
Ireland
Republic
of Ireland
England
(NHS)
England
(non-NHS)
Wales
Scotland
Northern
Ireland
Republic
of Ireland
Funded beds 
occupied
Intensive care
High dependency
Midday Wednesday
Midday Sunday

28 
PICANet 2020 annual summary report 
Additional data for ‘out of hours’ bed occupancy is reported in the Tables and Figures section 
of the PICANet Annual Report. 
Why is this important? 
Information about levels of bed occupancy is important for both the commissioners and 
providers of PIC to ensure that there is adequate provision of paediatric critical care beds. 
PICANet data was used to model and plan bed capacity in advance of the first wave of 
Covid-19. The NHS England recent paediatric critical care review also used this information 
to inform their review of the service. PICS standard L3 – 704 (2015) states that average bed 
occupancy on the unit exceeding 85% for more than two successive months should be 
specifically reviewed. The unit should be monitoring occupancy and there should be 
evidence of escalation within the Hospital and involvement of Health Boards/Commissioners 
if occupancy exceeds 85% for more than two successive months. Bed occupancy is also 
used as an NHS Services Quality Dashboard measure (PICO 5a). 
 
 


30 
PICANet 2020 annual summary report 
Metric 1: Case ascertainment and 
timeliness of data submission 
What are we measuring? 
Case ascertainment is a measure of the proportion of total admissions that are reported to 
PICANet. This is one aspect of data quality. 100% ascertainment would mean we received 
information for all admissions. 
We also measure the timeliness of data collection and present how many of the admission 
events are completed on the PICANet database within three months of discharge – a 
requirement of the PICS standards. An admission record was defined as complete when all 
validation checks had been fulfilled. Figure 7 shows the proportion of admission records 
defined as complete within three months of patient discharge in each country and Figure 8 
breaks this down further to look at individual PICUs. 
What did we find? 
Case ascertainment 
In the 11 PICUs visited in between 01 April 2019 and 31 December 2019, we were able to 
independently validate the number of PICU admissions in nine units (82%). In these nine 
PICUs, we found that almost all admissions (at least 95% in each unit) were reported to 
PICANet; five units had reported more than 99% of admissions. A review of the database 
following the validation was undertaken, resulting in the number of PICUs reporting more 
than 99% of cases increasing to six.  
Timeliness of data submission 
The completeness of patients’ admission data within three months of their discharge from the 
unit was 85.4% for the three year period from 2017 to 2019 across the UK (excluding 
Northern Ireland) and Republic of Ireland (Figure 7).  
Figure 7: Proportion of admission records completed within 3 months of 
discharge by country of admission, 2017–2019 
 
Northern Ireland excluded due to pause in data collection in 2018 
The ‘Overall’ category combines all admissions and calculates the timely completion rate overall, it is not 
calculated by taking an average of each unit’s completion rate 

Metric 1: Case ascertainment and timeliness of data submission 
31 
 
Northern Ireland was excluded when the reporting period was considered as a whole 
because data submission had to be paused in 2018 due to the introduction of the General 
Data Protection Regulation (GDPR) such that the unit could not submit within the required 
timelines. 
Wales had the highest rate of timely completion at 98%, followed by Scotland at 92% and 
Republic of Ireland at 89%. Within England, 84% of NHS PICUs and 77% of non-NHS PICUs 
completed within 3 months.  
Of the 31 PICUs (excluding Northern Ireland), 27 (87%) units had a timely completion rate of 
over 80% including nine units which had at least 98% of records complete within three 
months (Figure 8). One unit had 55% of data reported within the stipulated three month PICS 
standard and another had less than 50% of data reported within the timescale. 
When the most recent year of the reporting period was considered alone (Figure 8a), nine 
units had 100% completion within three months and a further 12 units had over 95% timely 
completion. Overall 88% of records were completed within three months, up from 81% in 
2017 and 82% in 2018. 

32 
PICANet 2020 annual summary report 
Figure 8: Proportion of admission records completed within 3 months of 
discharge by PICU, 2017–2019 
 
Organisation ZB excluded 
The ‘Overall’ category combines all admissions and calculates the timely completion rate overall, it is not 
calculated by taking an average of each unit’s completion rate 

Metric 1: Case ascertainment and timeliness of data submission 
33 
Figure 8a: Proportion of admission records completed within 3 months of 
discharge by PICU, 2019 
 
What does this mean? 
High levels of case ascertainment ensure that we are confident our findings will be 
representative of the events and care processes that take place in PICUs. PICUs in England, 
Wales, Scotland and the Republic of Ireland had high or very high standards of timeliness of 
submission of admission data. This is reflected in most units reporting the majority of their 
data within 3 months of patient discharge, although there were a small number of units which 
exhibited low rates of timely completion. 

34 
PICANet 2020 annual summary report 
Further details 
Definitions and methods 
Every PICU receives a validation visit from the PICANet research nurse on a rolling 
programme. At those visits, the numbers of admissions recorded locally are compared with 
the numbers held on the PICANet database. Any discrepancies are followed up by the PICU. 
This is called an ascertainment check. Not every PICU is visited each year, so our 
ascertainment check is based on those PICUs that have received a visit in the most recent 
year of the reporting period. We also monitor the timeliness of data completion, 
benchmarking against the PICS standard for reporting admissions to PICANet within three 
months of discharge from the unit. 
Why is this important? 
We want to base our analyses on all admissions to be sure that we can interpret our 
findings appropriately. If a significant proportion of admissions is missing we cannot be as 
confident about our conclusions. For example, if a number of admissions of children who had 
died on PICU were missing, we may make the wrong conclusion when comparing 
standardised mortality ratios (SMRs) between PICUs. Our high ascertainment rate therefore 
means that we can be confident about our findings. 
As well as ensuring we collect data on as many admissions as possible, we also want to 
ensure that data are collected in a timely manner, that data are accurate and that all relevant 
data are available for analysis. 
 
 


36 
PICANet 2020 annual summary report 
Metric 2: Retrieval mobilisation times 
What are we measuring? 
Some children need to be transported to a PICU in a different hospital for urgent care (non-
elective transports). For 2019, we have calculated how long it takes for the PIC centralised 
transport service (CTS) team to start their journey to pick up a child who needs urgent PIC 
following a clinical decision that PIC transport is required. The proportion of these journeys 
that started within 30 minutes, 31 to 60 minutes, 61 to 180 minutes, and over 180 minutes 
are presented for 2019 for the UK and Republic of Ireland overall. This information is 
summarised for the individual PIC transport teams. 
What did we find? 
More than half of the 12 organisations (T001, T002, T003, T004, T005, T008 and T024) 
mobilised within 30 minutes for more than half of the journeys. In 2019, five of the 12 
specialist PIC transport services mobilised their team within an hour more than 75% of the 
time (Figure 9). 
Findings for 2019 were very similar to 2018 with just under three fifths (59%) out of a total of 
4,262 journeys started within 30 minutes. Similarly just over 3 in 4 journeys (77%) started 
within one hour after the decision was made that the child required urgent transport. Just 
over 1 in 20 journeys (6%) started more than three hours after this decision. For the three 
year period 2017-2019 (Figure 10) the time taken to mobilisation is quite consistent with at 
least 77% of journeys started within one hour of the decision to transport each year. 
Figure 9: Proportion of non-elective transports mobilised by PICU CTS team by 
time to mobilisation: UK and Republic of Ireland, 2019 
 
 
Organisations are ranked by the NHS England 30 minute target, from which Northern Ireland, Scotland, Wales 
and the Republic of Ireland are exempt 

Metric 2: Retrieval mobilisation times 
37 
Figure 10: Number of non-elective PIC CTS transports mobilised by time to 
mobilisation: UK and Republic of Ireland, 2017-2019 
 
What does this mean? 
In the vast majority of cases, PIC CTS teams take less than an hour to start their journey to 
pick up a child who requires urgent critical care. The NHS England Quality Dashboard 
recommends that the team departs the transport base within 30 minutes from the time the 
referral is accepted for retrieval. Most PIC CTS teams aim to depart base within 30 minutes 
of accepting a child for urgent transport. In those cases where it takes longer for the team to 
depart, the reason for this may relate to the availability of staff, a transport vehicle or a PICU 
bed. 
At busy times identifying an available paediatric intensive care bed may delay departure and 
some journeys require road and air transport which also requires additional planning before 
the team can depart. 
Further details 
Definitions and methods 
Once a specialist transport organisation has agreed to transport a child they have a target 
set by the Care Quality Commission to start their journey within one hour and NHS England 
Quality Dashboard monitors the percentage of emergency retrievals undertaken where the 
team departs the transport base within 30 minutes from the time the referral is accepted for 
retrieval. Standards for mobilisation time have not been defined for the devolved nations and 
ROI. We measured the time from when the team agreed to the transport to the time they set 
off in the ambulance (or helicopter / plane) for what are called ‘non-elective’ or urgent 
transports – these are not planned transfers from one PICU to another or from a PICU to a 
district general hospital. 
 
 

38 
PICANet 2020 annual summary report 
Why is this important? 
Any delay in receiving intensive care could put the sick child at risk, as the referring hospital 
may not have the resources to look after a critically ill child. Delays in getting the team 
mobilised may just mean that it is very busy, e.g. during periods of ‘winter pressures’. 
Persistent delays may mean that there are insufficient resources in the transport organisation 
or there are some other organisational issues that need to be addressed. By measuring the 
time it takes to mobilise the transport team continuously over a long period of time PICANet 
are able to monitor and report back on PIC CTS performance, enabling the transport 
organisations to make changes to improve the quality of their service if appropriate. 
The time it takes the PIC centralised transport service (CTS) team to start their journey to 
pick up a child who needs urgent PIC care and the time taken by the team to travel, from the 
journey start point to the child’s bedside in the referring hospital, are added together to 
provide a measure called the ‘time to bedside’. 
Reaching the bedside of a critically ill child within three hours of agreeing the child requires 
urgent PIC care is a key target for Paediatric Critical Care Transport teams (PCCTs) to 
achieve in the United Kingdom. Whilst timely access to specialist care is necessary for these 
children, a study from England and Wales, undertaken by DEPICT4 showed no evidence that 
reducing the time-to-bedside target for PIC CTS teams will improve the survival of critically ill 
children. 
 
 


40 
PICANet 2020 annual summary report 
Metric 3: Number of nurses providing 
clinical care per bed 
What are we measuring? 
In November of each year, we ask PICUs to record how many clinically qualified nurses and 
non-registered health care staff are employed on their PICU: both their establishment (i.e. 
total funded posts) and any vacant posts. 
The Paediatric Intensive Care Society (PICS) Standards state a minimum number of 
7.01 Whole Time Equivalent (WTE) qualified (registered) nurses are needed to staff one 
level 3 critical care bed (2015). Non-registered staff with appropriate competencies may be 
included in calculations of staffing levels per child requiring critical care, so long as they are 
working under direct supervision of a registered nurse at all times. Previous PICS Standards 
(2010) endorsed the bench mark of 6.4 WTE qualified nurses to staff one level 3 critical care 
bed. 
What did we find? 
Overall, the establishment figures for PICUs across the UK and the Republic of Ireland show 
that in 2019 few units achieved either of the PICS standards. Six (18%) PICUs met 
7.01 WTEs per bed of clinically qualified nurses; this increased to eight (25%) when non-
registered health care staff (Bands 2-4) providing clinical care were included (Figure 11). 
Twelve (28%) PICUs met the previous standard of 6.4 WTEs (2010), without including non-
registered staff. 
However if all the recorded vacancies for qualified nurses and non-registered health care 
staff working clinically were filled, 16 (48%) PICUs would meet the standard of 7.01 WTEs 
per bed and 23 (69%) would meet the previous standard of 6.4 WTE. 
Figure 11: Number of clinically qualified nurses and non-registered staff 
providing clinical care in post (WTE) per bed by health organisation, 2019 
 
 

Metric 3: Number of nurses providing clinical care per bed 
41 
What does this mean? 
Based on the data provided by UK and Republic of Ireland PICUs in November 2019, a 
quarter of PICUs met the recommended standard of the Paediatric Intensive Care Society. 
The addition of bands 2-4 delivering clinical care has enabled two additional PICUs to meet 
this standard. However, despite few PICUs meeting these standards, staffing data from the 
census shows that the units ensure that their staffing levels are appropriate for the number of 
children on the unit and their care requirements. This may be achieved by unit staff working 
flexibly, undertaking additional shifts or using bank or agency staff. These data should be 
used to inform the future planning of PIC. 
Further details 
Definition and methods 
Each year PICANet carries out a staffing study to monitor staffing levels within PICUs and to 
audit the appropriate standards of the Paediatric Intensive Care Society: currently the PICS 
Quality Standards for the Care of Critically Ill Children (5th Edition, December 2015). Staffing 
data are collected in the November of each year: for the week beginning 11 November in 
2019, we present the percentage of PICUs meeting the recommended level of nurse staffing 
per funded critical care bed. 
The recommended number of nurses required (or nurse staffing establishment), in order to 
provide the appropriate levels of care for the number and given dependency of the bed, is 
calculated according to the PICS Standards for Intensive Care (one nurse to one bed) and 
high dependency (one nurse for every two beds). 
Why is this important? 
PICUs need to be able to monitor whether they have adequate nursing staff available to run 
their unit efficiently. PICS Standard L3-207 and guidance from the PICS Nurse Workforce 
Planning document for Level 3 Paediatric Critical Care Units, October 2016 states that ‘the 
minimum number of qualified nurses required to staff one level 3 critical care bed is a 
minimum of 7.01 WTE’. Non-registered staff (health care assistants) with appropriate 
competencies may be included in calculations of staffing levels per child requiring critical 
care so long as they are working under direct supervision of a registered nurse at all times.  
The availability of specialist PIC nurses is affected by many factors external to PIC including 
nursing salaries and the cost of living in capital cities. Staff recruitment and retention is 
currently under review as part of the paediatric critical care review. Some PICUs are 
developing the role of band 2–4 health care assistants to support qualified staff in delivering 
clinical care in critical care units. There is also additional concern about the effect of the 
ongoing Covid-19 pandemic on staff retention and recruitment in intensive care. 
 
 
 

42 
PICANet 2020 annual summary report 
Metric 4: Emergency readmissions within 
48 hours 
What are we measuring? 
For each PICU, we record the frequency of emergency readmissions within 48 hours of 
discharge in comparison to the average for the UK and Republic of Ireland (Table 7). This is 
calculated using the admission and discharge dates and times. The emergency readmission 
rate for each nation was calculated by dividing the number of emergency readmissions by 
the total number of admissions occurring in that nation for a given year. 
We also consider relative emergency readmission rates; these allow us to compare each 
PICU’s rate of emergency readmission within 48 hours with the equivalent rate over the UK 
and Republic of Ireland combined (Figure 12), by dividing their 48 hour emergency 
readmission rate by the combined UK and Republic of Ireland rate. Relative readmission 
rates higher than one indicate that a unit has a higher rate of emergency readmissions within 
48 hours than the overall rate for the UK and Republic of Ireland. 
What did we find? 
Between 330 and 350 children per year (or about 1.7 out of every 100 admissions) were 
discharged from PICU, but then readmitted as an emergency within 48 hours (Table 7). 
Rates of emergency readmissions remained fairly constant in England over the reporting 
period although there was a slight drop in 2019; Wales and Northern Ireland both saw a peak 
in emergency readmissions in 2018 with rates dropping again in 2019. Rates in Scotland 
slightly decreased in 2018 and this was sustained into 2019. In the Republic of Ireland, 
emergency readmission rates decreased slightly in 2018 but this was not sustained into 
2019. The rate of readmission for individual PICUs over the three years of the reporting 
period combined ranged between 0.4% and 2.7%. 
Table 7: Number of emergency readmissions within 48 hours 2017–2019 
Country 
2017 
2018 
2019 
2017-2019 
England 
270 (1.7%) 
272 (1.7%) 
251 (1.6%) 
793 (1.6%) 
Wales 
5 (1.0%) 
16 (3.1%) 
8 (1.6%) 
29 (1.9%) 
Scotland 
32 (2.3%) 
26 (1.9%) 
32 (1.9%) 
90 (2.0%) 
Northern Ireland 
5 (1.0%) 
14 (2.8%) 
8 (1.6%) 
27 (1.8%) 
Republic of Ireland 
24 (1.6%) 
18 (1.3%) 
26 (1.7%) 
68 (1.5%) 
Total 
336 (1.7%) 
346 (1.7%) 
325 (1.6%) 
1,007 (1.7%) 
Due to small numbers, data for non-NHS and NHS organisations in England are presented combined. 
The emergency readmission rate for each PICU for the 3-years of the reporting period 
ranged from 0.3 to 1.6 times the overall UK and Republic of Ireland rate. We would expect to 
see substantial variation in each PICU because of the low number of emergency admissions 
within 48 hours within each individual unit. 
Looking at each of the organisations individually (Figure 12), over the three-year reporting 
period 18 PICUs had lower rates of emergency readmissions within 48 hours than the 
combined rate with 11 of these having lower than the combined rate across all three years 
separately. Higher rates were observed for 15 PICUs with four of these have a rate at least 
1.5 times higher than the combined average.  

Metric 4: Emergency readmissions within 48 hours 
43 
Figure 12: Relative rate of emergency readmission within 48 hours of discharge 
by PICU 2017–2019 
 
Emergency readmission rates for each individual unit are relative to the overall rate of 1.68, the horizontal 
dotted line shows where a bar would sit if a unit had an emergency readmission rate that was exactly the same 
as the overall rate 
What does this mean? 
The proportion of patients requiring emergency re-admission within 48 hours of discharge 
from PICU was low in all countries, with around 1.7 per 100 admissions. There was 
substantial variation in the relative emergency readmission rate between PICUs and within 
PICUs year on year. 
Further details 
Definitions and methods 
We defined an emergency readmission within 48 hours as any unplanned admission to the 
same PICU within 48 hours of their last discharge from PICU. So if a child was admitted on 
1 March at 12:00 and discharged on 2 March at 17:00, but then admitted as an emergency 
(an unplanned admission) before 4 March at 17:00, they would have been counted in our 
analysis as they returned to PICU within 48 hours. We then calculated the number of 
emergency readmissions within 48 hours for every 100 admissions in each PICU to give a 
rate per 100 admissions. This allows us to compare PICUs with different numbers of 
admissions. 
There is no standard set for the acceptable rate of emergency readmissions within 48 hours, 
so in order to calculate relative rates we used the overall readmission rate for each specific 
year based on all PICUs contributing to PICANet as the standard. We then compared the 48 
hour emergency readmission rate for each individual PICU to this overall rate. When 
interpreting the data, PICUs with relative readmission rates below one have a lower 
readmission rate than that seen in the UK and Republic of Ireland combined and PICUs with 
a relative rate above one have a higher readmission rate. 

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PICANet 2020 annual summary report 
Why is this important? 
Emergency readmission within 48 hours is an undesirable outcome. From an individual 
child’s perspective, it suggests that their health has deteriorated in a short space of time and 
that they require further intensive care treatment. This will cause stress to the child, their 
families and their carers. For a busy PICU, each admission also creates additional demand 
on a service that usually operates close to capacity. 
It should be noted that although emergency readmission is used as a quality indicator, we 
cannot say that the sole or primary readmission was a reflection of the care provided. 
PICANet is therefore unable to assess whether the child was discharged too early, or into the 
wrong care environment, or whether the need for future intensive care was not foreseen. 
Relative rates of emergency readmission within 48 hours compared with the overall rate for 
the UK and Republic of Ireland show considerable variation year on year, although some of 
this variation could be due to small numbers of emergency readmissions within 48 hours in 
each PICU. This suggests that emergency readmission rates should be monitored on an 
ongoing basis. 
 
 


46 
PICANet 2020 annual summary report 
Metric 5: Mortality in PICU 
What are we measuring? 
Mortality (death) rates are assessed for every PICU based on a statistical approach that 
accounts for the severity of the child’s illness at the time of admission. This method is known 
as risk adjustment. The number of children who actually die (the ‘observed’ number) is 
compared to the number we predict to die (the ‘expected’ number, based on their clinical 
characteristics at the time of admission) to derive the risk-adjusted Standardised Mortality 
Ratio (SMR). The risk-adjustment method used to calculate expected mortality was the 
Paediatric Index of Mortality 3 (PIM3)4, which has been recalibrated, based on the data within 
this reporting period. Further details on recalibration can be found in the Tables and Figures 
document. 
What did we find? 
The risk-adjusted SMR for each PICU in the UK and Republic of Ireland is plotted in Figure 
13 according to the number of admissions for the period from 2017 to 2019. For the three-
year period combined there was no evidence that any PICU had an excess mortality rate 
compared to what would be expected. Three PICUs had a substantially lower mortality rate 
than would be expected even after allowing for natural variation, Middlesbrough, Edinburgh 
and Southampton. 
Figure 13: Risk-adjusted Standardised Mortality Ratio (SMR) by health 
organisation, 2017–2019 
 
Risk-adjustment based on PIM3 calculations recalibrated in 2020 

Metric 5: Mortality in PICU 
47 
What does this mean? 
After allowing for the level of sickness of the patient at the time of admission, no PICUs had a 
higher than expected mortality rate when the three-year reporting period was considered, 
and three PICUs had a substantially lower than expected mortality rate. 
 
How to read a funnel plot 
Figure 14 is a simple example of what a funnel plot might look like. The ‘funnel’ is created using 
statistical methods that tell us what range of values we might expect for mortality, given that there 
are normal ‘ups and downs’ (natural variation). The limits are wider where there are fewer 
admissions because with only a few observations we cannot be as certain about our findings. 
With more observations we can be more confident that the outcome is likely to fall within 
narrower limits. 
Figure 14: Example funnel plot 
 
The blue dots represent individual PICUs. They are plotted from left to right (horizontal-axis) 
based on the number of admissions to each PICU. 
The blue line in the middle of the funnel represents what is “expected”, in other words if a dot 
were to fall exactly on this line then this would mean that the number of deaths observed and the 
number of expected deaths are equal to each other (so there are no more or fewer deaths than 
we anticipate). It would be quite rare for a dot to fall exactly on this line and you would always 
expect a scatter of dots above and below this line. The whole point about funnel plots is to allow 
us to see differences between units taking into account natural variation. 
Any dot that falls within the funnel shape is within the limits of what we would expect to see so 
the number of observed deaths is no greater (or smaller) than the number we expect. We 
therefore have no concerns about PICUs with blue dots within the ‘funnel’. 
If a dot is above the funnel shape (like the red dot in Figure 14) we say that it is outside the upper 
limit and is a ‘statistical outlier’. This means that the number of deaths in the PICU are higher 
than the number we expect and that this is possible due to a cause other than natural variation. 
There are many reasons that a PICU could have a dot which lies above the upper limit including 
the fact we may not have properly accounted for how sick patients are when they enter the ward, 
or purely due to chance alone. We have a specifically designed process for investigating whether 
these PICUs really do have a higher number of deaths than expected and is a ‘true outlier’. 

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PICANet 2020 annual summary report 
Further details 
Definitions and methods 
Clinical data collected on admission are used in a statistical model to predict the probability 
that each child might die in PICU: the worse a patient’s clinical condition is on admission, the 
higher the probability that they might die. These probabilities are added up for each PICU to 
give an overall expected number of deaths in any one period. We then count the actual 
(observed) number of deaths and calculate what is known as a Standardised Mortality Ratio 
(SMR) by dividing the observed number of deaths by the expected number. We then use the 
funnel plot to assess the level of mortality in the PICUs against what is expected. 
Why is this important? 
Although death whilst receiving care on a PICU is extremely rare, it is important to assess 
whether more (or fewer) deaths than expected occur, as this can indicate that there is 
something different happening in a PICU. It only represents a statistical measure of mortality 
and it is very important to use this as an indicator that further investigation is required, not as 
a true measure of the quality of care delivered. 
 
 
 

References 
49 
References 
1. NHS England and NHS Improvement (2019). Paediatric Critical Care and Surgery in 
Children Review. Available at https://www.england.nhs.uk/commissioning/spec-
services/npc-crg/paediatric-critical-care-and-surgery-in-children-review/. Last 
accessed [18 Nov 2020] 
2. Kanthimathinathan, H.K., Durward, A., Nyman, A., et al. (2015) Unplanned extubation 
in a paediatric intensive care unit: prospective cohort study. Intensive Care Med 41, 
1299–1306. https://doi.org/10.1007/s00134-015-3872-4 
3. NHS England (2015). Level 3 – Paediatric Critical Care (PCC) Service Specification. 
Available at https://www.england.nhs.uk/commissioning/wp-
content/uploads/sites/12/2015/01/e07-sa-paed-inten-care.pdf. Last accessed [18 Nov 
2020]  
4. Seaton, S.E., Ramnarayan, P., Davies, P., et al. (2020) Does time taken by paediatric 
critical care transport teams to reach the bedside of critically ill children affect 
survival? A retrospective cohort study from England and Wales. BMC Pediatr 20, 
301. https://doi.org/10.1186/s12887-020-02195-6 
5. Straney, L., Clements, A., Parslow, R.C., et al. (2013) Paediatric index of mortality 3: 
an updated model for predicting mortality in pediatric intensive care. Pediatr Crit Care 
Med;14(7):673-81 https://doi.org/10.1097/PCC.0b013e31829760cf 
 
 
 


Additional information 
51 
Additional information 
Background 
PICANet was established in 2001 with funding from the Department of Health and started 
collecting data from English and Welsh paediatric intensive care units in November 2002. 
The PICUs at the Royal Hospital for Sick Children, Edinburgh and the Royal Hospital for 
Children, Glasgow started submitting data in December 2004 and March 2007 respectively. 
The Royal Belfast Hospital for Sick Children joined in April 2008 and Children's Health, 
Ireland, Crumlin and Children's Health, Ireland, Temple Street, both based in Dublin, have 
submitted anonymised data to PICANet since 2009 and 2010, respectively. The Harley 
Street Clinic PICU started contributing data in September 2010, and the PICU at the Portland 
Hospital from October 2013, allowing both these non-NHS units to compare their 
performance against the national benchmark provided by PICANet. 
A full list of participating PICUs can be found in Appendix A. 
Governance 
PICANet continues to receive support from the NHS Health Research Authority 
Confidentiality Advisory Group (NHS HRA CAG) (formerly the NIGB) to collect personally 
identifiable data without consent on infants and children admitted to paediatric intensive care. 
See https://www.hra.nhs.uk/documents/2143/piag-register-master-2019_LzQaqan.xls 
Ethics approval has been granted by the Trent Medical Research Ethics Committee, ref. 
18/EM/0267. 
PICANet supports transparency in its data processing and has patient information sheets 
and posters on display in PICUs and issues a Privacy Notice and Fair Processing Statement 
on its website outlining the legal basis for processing of data under the General Data 
Protection Regulations (May 2018). Details can be found at https://www.picanet.org.uk/. 
PICANet receives support and advice from a Clinical Advisory Group (CAG) drawing on the 
expertise of doctors and nurses working within the speciality and a Steering Group (SG), 
whose membership includes Health Services Researchers, representatives from the Royal 
Colleges of Paediatrics and Child Health, Nursing and Anaesthetics, a lay member and 
commissioners. Appendices B and C provide a full list of CAG and SG members. Additional 
support from the clinical community is provided through the UK Paediatric Intensive Care 
Society. 
Commissioning 
The following organisations commission paediatric intensive care in the UK: 
▪ 
England: NHS England Specialised Services  
▪ 
Wales: Welsh Health Specialised Service Committee (WHSSC) 
▪ 
Scotland: National Services Division of NHS National Services Scotland 
▪ 
Northern Ireland: Health and Social Care Board 
In the Republic of Ireland, Children’s Health Ireland, Crumlin and Children’s Health Ireland, 
Temple Street are both voluntary hospitals, funded by the Health Service Executive. 

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Methods 
Basic methodology 
Most critically ill children who need complex clinical care and life support are treated in 
Paediatric Intensive Care Units (PICUs). These children may have had complex surgery, an 
accident or a severe infection and may arrive in the PICU from an operating theatre, 
emergency department or from a hospital ward. In some cases they may have been 
transferred from another hospital and, rarely, admitted directly from home. 
PICANet is an audit that collects personal, organisational and clinical data on all children with 
a clinically determined need for paediatric intensive care in the UK and Ireland, to compare 
outcomes and activity between PICUs and specialist transport organisations and also 
between health regions and nations. 
Data are stored on a secure database. Each organisation is able to view and download their 
own data and reports on their data quality and activity as well as comparative national data. 
An annual report is produced each autumn that includes a summary of what has happened 
to children admitted to PICU including why they were admitted, where they were admitted 
from, how long they stayed, what treatments they received and their outcome at the time of 
discharge. Comparisons between PICUs are made to assess how well they perform against 
established clinical standards and guidelines. 
In addition to the annual report, PICANet provides technical and statistical support for the 
use of its data for local audit and research, regional and national commissioning, national 
and international research and to provide baseline information for clinical intervention trials. 
Participating organisations and data submission 
PICANet has collected data from all PICUs in England and Wales since 2002. The two 
PICUs in Scotland, one from Northern Ireland and two from the Republic of Ireland, along 
with two non-NHS units based in London have joined PICANet at different times so that 
coverage is now for the whole of the UK and the Republic of Ireland. There are 32 PICUs 
and 12 specialist transport organisations currently submitting data to PICANet.  
Data are submitted by individual PICUs prospectively, using our secure web-based data 
collection application with real-time online validation reporting, systematic monthly validation 
review by our research nurse and regular on-site validation visits. Data submission can 
involve direct entry of patient data or an upload of a data file from an existing clinical 
information system. PICANet provides full documentation on data definitions, which have 
been developed in collaboration with our Clinical Advisory Group, as well as technical 
specifications for IT and database professionals. In addition, standardised data collection 
forms are supplied to all organisations where there is no in-house provision for data 
collection. 
Data collected 
PICANet collects three core datasets: 
Admission data contains demographic details of each child including their name*, date of 
birth**, NHS/CHI number, address* and ethnic group; it also records where children are 
admitted from, their date of admission and clinical diagnoses, some physiological parameters 
on admission including blood gases, blood pressure, medical history and ventilation status. 
Data on outcome and discharge details are included. The medical interventions received on 
each day by each child are recorded as part of the audit and to help NHS organisations in 
England to supply information on the cost of their activity. 

Additional information 
53 
Referral data for all children where clinicians agree a paediatric intensive care bed and/or 
paediatric intensive care transport is required includes details of the referring hospital, 
demographic details of the child, grade of the referring doctor or nurse, the outcome of the 
referral, the transport team involved and the destination PICU. 
Transport data for all children transported to a PICU from their original admitting hospital or 
who are transported by a specialist PIC transport service but are not admitted to a PICU 
includes patient details as well as information about their presenting physiology. Details of 
the composition of the transport team, journey times, any interventions carried out and critical 
incidents are also recorded. 
Additional data collection takes place to understand more about staffing on PICU: 
Staffing data are collected each year in November to monitor staffing levels within PICUs as 
well as the PICS standards relating to staffing requirements. 
* Not collected for data from Northern Ireland or the Republic of Ireland 
** Limited to month and year for Northern Ireland 
Analytical techniques 
Statistical techniques used include simple cross tabulations, the calculation of crude and risk-
adjusted SMRs and 95% confidence intervals; the construction of crude and risk-adjusted 
funnel plots of SMRs; and local provision of Risk Adjusted Resetting Sequential Probability 
Ratio Test (RA-RSPRT) plots to assess real-time performance related to in-PICU mortality. 
Risk adjusted SMRs were calculated using the latest version of the Paediatric Index of 
Mortality (PIM33) recalibrated based on data within the current reporting period. 
Assessing case ascertainment, data quality and validation 
PICANet Web allows PICU staff to obtain reports on their own data to check monthly 
admissions totals. In addition, during validation visits by the PICANet research nurse a cross 
check is carried out against records held on PICU (such as admission books, or in-house 
data collection systems) and PICANet Web. These checks allow us to assess case 
ascertainment and the on-site validation visits are a core element of our data quality 
assurance process. 
Data are validated online via PICANet Web using logic and range checks as well as flagging 
missing data items. The Modulus 11 algorithm is used to validate the NHS number based on 
a check digit – this is a standard method of ensuring the NHS number is a true NHS number 
and improves our ability to trace patients through the PICANet database and in linked 
healthcare data. 
Collaborative working supporting policy, commissioning, 
research and clinical trials 
PICANet has become established as the definitive source of data on paediatric intensive 
care activity in the UK and Ireland. Its data have been used to plan PIC services, model 
demand, assess interventions and outcomes and provide data to underpin research to 
facilitate the development of new standards for critical care provision for children. PICANet 
has provided baseline data for the development of the I-KID, SANDWICH and FEVER trials, 
all of which have been funded and will make use of the routinely collected PICANet data 
using the custom data download facility. This allows local control over the data. We are also 
working closely with a number of other funded studies, including DEPICT, ENACT, FIRST-
ABC, LAUNCHES-QI, Neuro-PACK, OXY-PICU, PERMIT, PREVAIL and QualDash. 

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PICANet 2020 annual summary report 
Small number policy 
Publication of PICANet data is subject to scrutiny of small numbers. When small numbers of 
admissions are involved, other data items may become identifiable i.e. a living individual may 
be identified from the data. This is still the case in aggregated data where small groups of 
individuals are presented. These are reviewed and in some cases, categories are combined 
or cells anonymised where necessary. 
Outlier policy 
When unusual performance is detected following routine or bespoke analysis, which 
suggests that a PICU is an outlier, PICANet follow the established procedure outlined in our 
outlier policy, which relates specifically to assessment of risk-adjusted mortality. 
Historically there have been three specific occasions where PICUs have been identified as 
outliers with excess risk-adjusted mortality. In two of these cases this was attributable to data 
quality issues and when corrected, the outliers fell within normal limits. In one case this was 
not attributable to data quality and resulted in internal and external reviews. 
Links with the clinical community, patients and their families 
PICANet has until recently had an active PICU Families Group comprising both Lay 
representatives (parents of children who are currently or have previously received paediatric 
intensive care) and a multidisciplinary group of health professionals including Family Liaison 
Sisters, critical care nurses, audit staff, PIC consultants and members of the PICANet team. 
Availability of Lay representatives has become difficult over recent years and so we are 
developing a Lay stakeholder group encompassing any PIC or disease specific support 
group that deals with parent or child PIC related issues to feed into the future development of 
PICANet. In addition, we have a standing lay representative on our Steering Group and work 
closely with the charity Well Child. To date, all communications we have had from 
patients/parents have been very positive, supporting PICANet and its work and requesting 
further information. 
PICANet has the support of the Paediatric Intensive Care Society and the associated PICS 
Study Group, the PICANet Clinical Advisory Group and the Clinical Reference group which 
oversees Paediatric Critical Care and PCC transport. 
 
 
 
 

Additional information 
55 
Glossary 
CAG 
Clinical Advisory Group 
CCG  
Clinical Commissioning Group  
CHI 
Community Health Index 
CTS 
Central Transport Services 
EC 
Enhanced care 
ECLS  
Extracorporeal life support 
ECMO 
Extracorporeal membrane oxygenation 
GDPR 
General Data Protection Regulation 
HD 
High dependency 
HFNCT 
High flow nasal cannula therapy 
HQIP 
Healthcare Quality Improvement Partnership 
HRA 
Health Research Authority 
HRG  
Healthcare Resource Group 
IC 
Intensive Care 
NCAPOP 
National Clinical Audit and Patient Outcomes Programme 
NHS 
National Health Service 
NOCA 
National Office of Clinical Audit 
PIC 
Paediatric Intensive Care 
PICANet 
Paediatric Intensive Care Audit 
PICS 
Paediatric Intensive Care Society 
PCCS 
Paediatric Critical Care Society 
PICU 
Paediatric Intensive Care Unit 
PIM3 
Paediatric Index of Mortality 3 
RA-RSPRT 
Risk Adjusted Resetting Sequential Probability Ratio Test 
ROI 
Republic of Ireland 
SG 
Steering Group 
SMR 
Standardised mortality ratio 
UK 
United Kingdom 
WHSSC 
Welsh Health Specialised Service Committee 
WTE 
Whole time equivalent  
 
 
 

 
 
Richard Feltbower 
Hannah Buckley 
Sophie Butler 
Victoria Hiley 
Lee Norman 
Benjamin Fox 
 
 
PICANet 
Leeds Institute for Data Analytics 
School of Medicine 
University of Leeds 
Clarendon Way 
Leeds 
LS2 9JT 
 
Elizabeth Draper 
Caroline Lamming 
Lyn Palmer 
Martin Perkins 
Sarah Seaton 
 
 
PICANet 
Department of Health Sciences 
University of Leicester 
George Davies Centre 
University Road 
Leicester 
LE1 7RH 
University of Leicester 
University of Leeds 
www.picanet.org.uk 
xxx@xxx.xx