1. Capacity (based on the type of commissioned bed)

Capacity should reflect the commissioned number of beds at the census time each day

1.1 Paediatric critical care - commissioned capacity

The commissioned number of critical care beds, whether vacant, occupied or closed (see below for definition of closed beds).
Critical care beds are staffed based on the following nurse to child ratios:
• Level 3 - 1:1
• Level 2 - 1:2

1.2 General acute paediatrics - commissioned capacity

The number of commissioned general acute paediatric ward and assessment unit beds, whether vacant, occupied or closed (see below for definition of closed beds).
Ward beds occupied by patients requiring enhanced care are staffed based on the following nurse to child ratio:
• Level 1 – 1:3 or 1:4 dependent on patient mix

1.3 Neonatal - commissioned capacity

The number of commissioned neonatal care beds, whether vacant, occupied or closed (see below for definition of closed beds).
Neonatal cots should be staffed based on the following nurse to baby ratios:
• Intensive Care 1:1
• High Dependency 1:2
• Special Care 1:4

2. Occupancy (based on level of care provided)

2.1 Paediatric critical care - Level 3

Number of beds occupied by patients receiving advanced critical care through invasive ventilation.

2.2 Paediatric critical care - Level 2 intermediate critical care (HDU level 2)

Number of beds occupied by patients receiving intermediate critical care through
• Care of tracheostomy
• Non-invasive ventilation (CPAP/BiPAP)
• Long term ventilation via a tracheostomy

2.3 Paediatric critical care - Temporary Level 2/3 beds outside critical care unit

Number of beds occupied by patients receiving intermediate/advanced critical care in other settings, e.g. patients intubated in theatre or holding area.

2.4 Level 1 basic enhanced care (HDU level 1)

Number of beds occupied by patients receiving basic enhanced care through
• Oxygen therapy plus continuous pulse oximetry plus ECG monitoring
• Nasal high flow therapy

2.5 General medical/surgical paediatrics

Number of beds occupied by patients receiving non-critical care treatment on a general medical/surgical paediatric ward.

2.6 Paediatric assessment unit

Number of beds occupied by patients receiving non-critical care treatment on a paediatric assessment unit.

2.7 Neonatal intensive care

Number of cots occupied by babies receiving intensive care.
Neonatal intensive care is care provided for babies who are the most unwell or unstable and have the greatest needs in relation to staff skills and staff to patient ratios. This includes any day where a baby receives any form of mechanical respiratory support via a tracheal tube, both non-invasive ventilation (e.g. nasal Continuous Positive Airway Pressure (CPAP), SIPAP, Bilevel Positive Airway Pressure (BIPAP), nasal high flow) AND Parenteral Nutrition (PN), day of surgery (including laser therapy for retinopathy of prematurity (ROP)) and on day of death or any conditions listed as per BAPM categories of care.

2.8 Neonatal intensive care stabilisation

Number of stabilisation cots occupied by babies receiving intensive care as per the definition of neonatal intensive care above.

2.9 Neonatal high dependency

Number of cots occupied by babies receiving high dependency care.
High Dependency care is provided for babies who require skilled staff but where the ratio of nurse to patient is less than intensive care. This care takes place in a neonatal unit where a baby does not fulfil the criteria for intensive care but receives any form of non invasive respiratory support (e.g. nasal, CPAP, SIPAP (infant flow system with multiple modalities), BIPAP, nasal High Flow, parenteral nutrition or continuous treatment of their condition as per BAPM categories of care.

2.10 Neonatal special care

Number of cots occupied by babies receiving special care.
Special Care is provided for babies who require additional care delivered by the neonatal service but do not require either intensive or high dependency care. It includes babies receiving oxygen via low flow nasal cannula, feeding by nasogastric tube, jejunal tube, or gastrostomy, continuous physiological monitoring, care of stoma, presence of an intra-venous (IV) cannula, receiving phototherapy or special observation or physiological variables at least 4 hourly.

3. Additional definitions

3.1 Additional capacity

The number of additional beds that can be staffed and made available (excluding those reported as part of current capacity). This should change dynamically in line with local response plans, e.g. beds available from 24 hours onwards today that are subsequently made available should move to current capacity.

3.2 Total potential capacity

Calculated field:
(total commissioned beds) + (additional beds that can be staffed from 24 hours onwards)
This denotes the total potential additional capacity available in addition to current capacity.

3.3 Beds occupied by CAMHS, eating disorders and safeguarding patients

Of the total number of beds occupied, the number occupied by patients requiring additional nursing support for:
• CAMHS
• Eating disorder
• Safeguarding

3.4 Delayed transfers of care

The number of delayed transfers of care >4 hours after the reported time fully ready for discharge (or step down/up to next level of care).

3.5 Closed and flexed beds

The number of beds closed or flexed for any reason including staffing. As well as for reporting the number of closed beds, this section should also be used to illustrate where acuity of casemix necessitates changes to the numbers of beds at each level of care from the commissioned baseline, e.g. if a bed is flexed from level 3 to level 2, the number of closed beds at level 3 should be increased, and the number closed at level 2 decreased, even if that means reporting a negative value.
Note that any paediatric beds occupied by adults should also be reported as closed as these will be reported on the adult sitrep.

3.6 Vacant beds

Calculated field:
(total commissioned beds) - (total occupied) - (closed beds)
Note that, when beds are flexed from the commissioned baseline, the number of vacant beds may show a negative value, e.g., where a patient requires level 3 care at a site where there are no commissioned level 3 beds, and bed occupancy is therefore greater than the commissioned capacity.

3.7 % Occupancy

Calculated field:
(total occupied) / [ (total commissioned beds) - (closed beds) ]

3.8 Escalation status

The escalation status values for the unit/ward, as defined by NHS Wales Operational Pressure Escalation Levels (OPEL). This column should be completed for all relevant rows for the hospital, i.e. if each row constitutes a separate unit, complete for each row, otherwise complete total row. Both the escalation status and staff declaration category should be supplied in the same cell, e.g. 1A, 3.1B, etc. Please see link to OPEL sheet below for details of the applicable values.

https://dhcw.nhs.wales/information-services/information-standards/data-standards/data-standards-files/all-wales-paediatric-opel-levels-october-2021-pdf/

3.9 Staff shortfall

The number of staff short of agreed establishment. This complements the escalation status staffing category with additional details of staffing pressures.

3.10 Supporting information

A free text comments box for any further information to support the submission, e.g., reasons for changes in capacity, closed beds, or DToCs, as well as any additional capacity, such as stabilisation cots. Please use this column freely to provide as relevant much information as possible, up to 500 characters.
Note that supporting information must be supplied when any cell in the relevant row turns red to denote that it requires validation.