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2. 2 Provincial Paediatric Critical Care Response Team (PCCRT) Initiative The Extramural Program

3. 3  Ontario’s Critical Care Strategy seeks to improve access and quality by addressing issues that contribute to wait times for critical care  7 priority areas have been identified and funded  CCRT’s & PCCRT’s are a core priority for the Strategy

4. 4 What are PCCRT’s?  The PCCRT intramural service helps ward staff provide critical care to children on hospital wards who are at risk of deterioration  The MOHLTC and the Ontario PCCRT Working Group have been looking at ways of extending the benefits of PCCRTs outside the walls of the tertiary care centres and into to the community hospitals

5. 5 Outside the Walls The Rationale for Extramural PCCRT  Community hospitals are often the first point of contact into the health care system for children with critical illnesses  Community hospitals have fewer paediatric acute care resources available  Initial stabilization and hands-on management occurs in settings with limited acute care paediatric resources

6. 6 Extramural PCCRT: Physician to Physician  The extramural service involves a paediatric intensivist who is on-call to support physicians in other hospitals who may be caring for critically ill children  Any hospital physician that is caring for a critically ill child in Ontario can access the extramural PCCRT service through CritiCall

7. 7 Extramural PCCRT Goals Access to a paediatric intensivist will:  Support the physician caring for the critically ill child  Potentially reduce need for critical care transport or prolong period of stabilization prior to transport team arrival  Improve early access to paediatric intensivist involvement in care

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9. 9 What You Get When You Call the PCCRT  A coordinated service requiring only a single phone call to access the following services:  Paediatric Critical Care Expert Advice  Paediatric Critical Care Transport Resources  Provincial Paediatric Critical Care Bed Availability  Use of conferencing technology to improve communication between physicians from different centers to avoid repetition of information and delays in accessing care

10. 10 What If Transport Out of Region Is Required?  Via CritiCall, the Paediatric Critical Care Response Team physician (PCCRT MD) from the regional tertiary referral centre, will remain the consistent point of contact even if transport is required to another institution until an accepting physician is identified  Following transfer of information from the PCCRT MD to the accepting MD, all further communication to the community physician will occur from the accepting physician

11. 11 Quality Assurance  Digital recording technology at each tertiary referral centre will allow more detailed review of difficult cases and improved system delivery  Province-wide uniform data collection on advice calls and critical care transport outcomes

12. 12 For further information: www.criticall.comwww.criticall.com www.health.gov.on.ca/english/providers/program/critical_care/cct_strategy.html