In many health systems, specialist services are organised on a regionalised basis whereby large facilities are located in areas of high population.
In some specialities [1–4], it has been shown that regionalisation may offer improved patient outcomes by concentrating clinical resources and expertise, and by the range of clinical problems and professional development opportunities that higher caseloads present. Economically, regionalisation may also be a cost-effective way to provide specialist public health services .
While regionalisation may have benefits, it may also disadvantage sectors of the population who live some distance from care. Queensland is a large state with an area of greater than 1.7 million square kilometres and a population of 4.5 million. While the majority of the state’s population live in the south east corner and in large regional centres along the east coast, a significant number of people live inland in large centres, smaller towns and isolated communities .
Queensland’s public health system has a responsibility to provide an appropriate level of care for its residents regardless of their geographic location. Because many specialist health services are regionalised to larger centres, meeting this responsibility presents significant challenges. In some cases, health care services have been centralised, for instance care for critically ill children, the subject of this work, is provided by a central service (the Queensland Paediatric Intensive Care Service). Under this arrangement, services are provided by two paediatric intensive care units (PICUs) at the Royal Children’s Hospital (RCH) and the Mater Children’s Hospital (MCH) located within 6 km (3.7 miles) of each other in Brisbane. Where necessary, emergency retrieval services are used to transport children to an appropriate level of care using road ambulance, helicopter or fixed-wing aircraft, with the mode of transport being determined by distance, terrain and by the child’s condition.
For families in regional or remote areas, the centralisation of PICU services can result in distance and time impediments to urgently needed health care. In some cases, children from these areas may be managed in regional centres closer to their home where the population may be sufficient to support a sophisticated general intensive care unit (ICU) . Such local management has advantages: it avoids the risks associated with transport; it reduces dislocation from family and community; and it relieves pressure on PICU services . However, there may also be disadvantages: research suggests that children have better outcomes when treated in paediatric focused facilities rather than general intensive care services [8, 9].
To the authors’ knowledge, the effect of geography on health care for critically ill children in Queensland has not been described. Thus, this study aims to provide new information on service availability, spatial accessibility, service utilisation and retrieval cost for children who require intensive care services, but who present away from a tertiary facility.