Quality Improvement Resources

PICANet’s key quality improvement (QI) resources for participating organisations are detailed below and you can read about PICANet’s healthcare improvement goals in our Healthcare Quality Improvement Plan.

If you have conducted an effective QI project involving PICANet data/ using any of these resources we would like to hear from you. Please contact us at [email protected] 

PICANet's Key Metrics

PICANet’s key metrics cover the whole patient pathway from initial referral to paediatric intensive care, specialist transport, and inpatient care.  

The PICANet Key Metrics Definitions details the current metrics and the Supporting quality: PICANet’s key metrics document outlines the processes and quality improvement resources available to aid participating organisations to collect complete, good quality data that feeds into the metrics and respond to areas that show as a cause for close monitoring or concern. 

Risk-adjusted resetting sequential probability ratio test (RSPRT) plots
Real-time ‘RSPRT’ plots enable PICUs to monitor their mortality outcomes on a timely and regular basis. RSPRT Guidance for Units is available to assist PICUs in identifying and responding to potential issues with quality of care in a time-sensitive fashion. The guidance includes a case study from a PICU team that responded to a RSPRT reset which was a cause for concern requiring internal review. Further to the case study in the guidance, the PICANet Annual Meeting 2022 discussion session, PICANet RSPRT in PICU, is available on our website. This features two PICU clinicians talking about their experience of using RSPRT plots to monitor mortality in their units.  

Having a cause for concern RSPRT status does not mean that the PICU will be identified as a potential outlier in the formal outlier analysis which is based on standardised mortality ratios. Should a unit be identified as a potential positive or negative statistical outlier for risk-adjusted in-PICU mortality, the PICANet Outlier Policy will be followed.  

National Clinical Audit Benchmarking Program (NCAB), England                                                                              PICANet’s key metrics are reported to the Care Quality Commission (CQC) annually to inform inspection planning of NHS and private hospitals in England and are publicly available on the NCAB portal along with each provider’s performance the previous year, the national average and, where applicable, national standard. 

PICANet Data

Local data downloads and reporting                                                                                                                                            All participating organisations are able to access real-time local data downloads and reporting to support and stimulate QI projects. The Event Summary Viewer can be used to filter and plot data by various characteristics and timelines. The data behind the charts can be downloaded. 

PICANet State of the Nation Report Interactive Charts and Data                                                                                      For each report we provide detailed information in interactive charts with associated data tables for a selection of outcomes. There are also two core Excel files for Mortality Data (Standardised Mortality Ratios) and Data Quality (Data Completeness and Case Ascertainment). We archive the charts from previous reports. You can find them on the Annual Report Archive page.

These charts and their associated data downloads can be used to enable participating organisations to assess and monitor their performance against other PICUs or transport services to inform local and regional QI initiatives. 

PICANet Data Dashboard

The PICANet Data Dashboard is a selection of charts showing data relating to some of PICANet’s key metrics. Clinical teams involved with patient care can use these along with other resources that PICANet provide to develop local quality improvement strategies and compare compliance with audit performance metrics.

Data Collection Resources

PICANet’s data collection forms, manuals and guidance are available online.

We have released a set of resources for developing imports into PICANet Web for all event types. The file includes the PICANet upload XML Schema Definition file (xsd), a list of isolation reasons used in the PICANet dataset and our organisation list. Some participating organisations find that making their submission of data more automated, can reduce some of the data burden locally. You can find this resource within each of the dataset resource pages.

Ethnicity Data Collection

Guidance and resources for asking about ethnicity, collecting and recording it are available from Ethnicity – NHS Digital, which signposts to Improving ethnicity data collection for health statistics in the UK (IQBAL, Gulnaz, GUMBER, Anil, JOHNSON, Mark R.D, SZCZEPURA, Ala, WILSON, Sue and DUNN, Janet A (2009). Improving ethnicity data collection for health statistics in the UK. Diversity and Equality in Health and Care, 6 (4), 267-285).

Healthcare Associated Infections Data Collection

PICANet provide expanded dataset definitions and frequently asked questions for the healthcare associated infections (HCAI) data. This includes some example scenarios for determining PICU-acquired central line associated bloodstream infection (CLABSI) according to the criteria.

If your unit has designated personnel who are instrumental to gathering, recording and validating HCAI data for submission to PICANet, please do make PICANet aware of them so that we can direct any specific data validation queries to them.

For further information on CLABSI and catheter associated urinary tract infection (CAUTI) you can refer to the following:

General information surrounding HCAI can be found here:

  • epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England                                                                                                                                                                                Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, Browne J, Prieto J, Wilcox M, UK Department of Health. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2014 Jan;86 Suppl 1:S1-  70. doi: 10.1016/S0195-6701(13)60012-2. PMID: 24330862; PMCID: PMC7114876.

Articles regarding CVC bloodstream infections in ICU:

Delirium Screening Result Data Collection

If personnel in your PICU are trained to use one of the following validated screening tools adopted by your unit, then delirium screening result data can be completed.

  • Cornell Assessment of Pediatric Delirium (CAPD)
  • Sophia Observation withdrawal Score-Paediatric Delirium (SOS-PD)
  • Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU)
  • PreSchool Confusion Assessment Method for the Intensive Care Unit (psCAM-ICU)

Units not using a validated paediatric tool for screening should leave these fields blank until screening is introduced. The CAPD tool is the most commonly used screening tool.

The Paediatric Delirium Group UK and Ireland (PDGUKI) make training and screening resources for the CAPD tool available online. They also provide guides and templates for screening compliance audits for the CAPD and SOS-PD tools.

The group host monthly virtual meetings to facilitate shared experience of establishing delirium screening within PICUs across UK & Ireland. The meeting schedules can be found on their website.

PICANet are in regular contact with the team at PDGUKI to find out which units have completed training and started screening. We will then contact those units to confirm data entry start dates.

PICANet Reports and Meetings

The latest annual State of the Nation Report is available on the Reports and publications page and previous editions are available in the Annual Report Archive 

Traditionally PICANet host an Annual Meeting for participating PICUs and Specialist Retrieval and Transport Services. PICANet report findings are presented and associated QI topics discussed.  

Video recordings of the talks given at the Annual Meeting held on 26 Jan 2022 are available on our website.  

PICANet Data Driving QI Projects

The PICU team at the Royal Hospital for Children and Young People, Edinburgh have shared their successful QI Project example. You can read how they have improved their recording of pupil reaction from around 46% to on average 95%.

If you would like to find out more about this project, please contact [email protected] and we can pass your queries on to the team.