Clinicians across Orange Health Service in Western NSW Local Health District (WNSWLHD) are improving timely access to paediatric critical care equipment through the implementation of a specialised critical care equipment trolley.
Paediatric resuscitation adds an additional layer of stress and cognitive load to clinicians involved, especially when they have minimal exposure to paediatric resuscitation in clinical scenarios or simulations.
In 2023, the Paediatric Resuscitation Steering Committee at the service worked collaboratively to improve access, familiarity and skill in the use of advanced paediatric equipment, with the aim to optimise the management of the high acuity patient within the service, a regional level 4 hospital. From this collaboration came ‘The Yellow Trolley’ – it is yellow in colour, so that staff are able to recognise it easily when needed.
Across WNSWLHD, Broselow Trolleys are used for paediatric resuscitation and contain first-line resuscitation equipment. However, in critical situations, sourcing additional equipment required is challenging and time consuming. Before our intervention, each department at the service kept their own required paediatric equipment in stock, with consumables specific to each individual unit.
Generally, during critical events requiring advanced paediatric equipment not included in the standard Broselow Trolley, staff were diverted from clinical care to consult with multiple departments to source equipment. If the required equipment was not available, adult equipment was often adapted and used. This was time-consuming and posed potential clinical risk.
To address these barriers, we’ve implemented the Yellow Trolley in addition to the standard Broselow Trolley. The Yellow Trolley includes additional equipment to support the management of high acuity children while awaiting retrieval to a tertiary paediatric facility.
Improved clinical safety for high acuity children
Introducing the Yellow Trolley has supported staff in ensuring key pieces of equipment and consumables are kept in a known, centralised location and easily accessible by all departments as required.
By keeping the Yellow Trolley in a central location in the ED, it is transferrable to the bedside of the child at any location in the hospital. We have designed the Trolley to be used in conjunction with the Broselow Trolley and includes equipment beyond its scope.
This includes:
- paediatric arterial and central lines
- paediatric invasive and non-invasive ventilation consumables
- chest drain equipment
- indwelling urinary catheters.
We developed the equipment list in collaboration and consultation with all relevant clinical areas within the service, the Neonatal and Paediatric Emergency Transport Service and the tertiary Paediatric Intensive Care Unit. It has been reviewed to meet minimum additional equipment requirements as set out by the Agency for Clinical Innovation for managing high acuity children outside of a tertiary children’s hospital.
The Yellow Trolley also contains user resources to support staff, such as Quick Reference Guides for key pieces of equipment. Equipment not currently stocked within departments is ordered and stored within the paediatric ward, so it is available to restock the Yellow Trolley when equipment has been used. This reduces the cost of equipment across all departments, and minimises waste by reducing expired equipment.
Staff feel more supported in their clinical practice
Since implementing the Yellow Trolley into clinical practice, staff feedback has been overwhelmingly positive. Clinicians report feeling more comfortable and better supported when caring for high acuity paediatric patients. To support the rollout, we provided targeted education and developed local operating procedures. This further contributed to the positive response from staff.
Improved focus on patient care
With the Yellow Trolley in place, clinicians can focus more on patient care and are more confident while stabilising a high-acuity patient until the retrieval team arrives. The Yellow Trolley has also become a valuable teaching resource. It enhances simulation training and strengthens paediatric clinical skills among nursing staff who were previously less familiar with managing high-acuity paediatric presentations across the hospital.
Centralised equipment reduces delays
Equipment that was identified as necessary to support the high acuity patient in a regional level 4 hospital is now centralised in one location, preventing delays in treatment while sourcing equipment. This has improved the patient journey for high-acuity paediatric patients while awaiting retrieval. This is particularly important when there are delays in Neonatal and Paediatric Emergency Transport Service retrievals due to competing demands across the state.
Collaborative approach drives success
Our collaborative approach used in planning and implementing the initiative has been central to its success. The team was able to identify the appropriate equipment and work together to finalise the overall equipment list by drawing on the strengths and expertise of multiple clinicians and disciplines across the hospital, including medical and nursing team members working in paediatrics, emergency, intensive care and perioperative services. This cross-department collaboration fostered a strong sense of ownership and engagement across the facility, increasing both uptake and acceptance of the initiative among clinicians in all departments.
