McMaster Childrens Hospital
Extramural Pediatric Critical Care Response Team
(PCCRT)
Background
The extramural PCCRT team at MCH was constructed with funding from the Ontario Ministry of Health to provide pediatric critical care support to our community hospital partners. On a 24/7 basis a pediatric intensivist can be reached via CritiCall© to provide telephone advice to community physicians providing care for critically ill or unstable children and to facilitate transfer of these patients to a tertiary care pediatric intensive care unit. The provincially run CritiCall© system provides a 1 number to call (1-800-668-4357) service to seamlessly connect all relevant health care providers (community MD, pediatric intensivist, subspecialists, transport team, etc.) to a bridged, recorded line where advice can be provided and transport arranged.
Across the province of Ontario, critically ill children are referred to tertiary care PICUs according to geographic boundaries. On occasion, a regional PICU within a given boundary may not have a bed available into which the patient can be accepted; under that circumstance, it is the regional intensivists responsibility to provide telephone advice to stabilize the patient and to request that CritiCall© assist in finding an alternate PICU outside of region – once a bed is found a formal handover between intensivists is required.
Extramural PCCRT at McMaster
At McMaster, the extramural PCCRT service is provided by the PACE Staff Physician (a Pediatric Intensivist) and PACE Fellow (a Pediatric Critical Care Subspecialty Resident or Fellow) On-Call. On activation of a extramural PCCRT call (CritiCall©) the PACE staff and fellow will be paged and are required to call into the PICU bridge line (ext 74993); this is a dedicated, recorded line in the PICU that is used exclusively for extramural PCCRT calls. Because these calls are of a potentially critical nature, it is essential that when paged, the on-call physicians call into the unit immediately. Once both the PACE staff MD and fellow are both on the line, the call will be bridge in with CritiCall© and the referring physician. It is a provincial mandate that the Staff MD MUST be on the line for all initial calls and for any subsequent calls regarding the same patient where advice is being provided.
Possible outcomes of an extramural PCCRT call include provision of advice only without transfer to McMaster (for stable patients), provision of advice and transfer to the PICU (for critically ill patients) or provision of advice and transfer to an alternate service at McMaster (eg. ED, general pediatrics, subspecialty service)(for children requiring tertiary care outside of the PICU). In the case where a patient is being transferred to McMaster to an alternate service, it is essential that there is a conversation with that service to ensure willingness of that service to assume care and to formally hand over the patient. Whenever it is deemed to be helpful, subspecialty providers can be bridged into a transport call to provide advice and optimize communication.
All extramural PCCRT calls must be formally documented on the PCCRT forms found in the PICU adjacent to the bridge, transport telephone.
Critical Care Transport in Ontario
The current system for transporting critically ill children in Ontario relies on several different resources including the provincial ORNGE transport team (a specialized critical care team), local specialized NICU teams (at McMaster this serves infants less than 5 kg and 28 days) and local EMS teams (nonspecialized). In all cases whenever a child is to be transferred to McMaster there must be discussion and agreement between referring and receiving services on the optimal transport system taking into consideration team availability, patient acuity, and duration of transport.