Critically ill children in non-paediatric intensive care units: a survey, review and proposal for practice

Area of Science:

• Pediatric Critical Care Medicine
• Healthcare Management
• Health Services Research

Background:

• Centralization of critically ill children to pediatric intensive care units (PICUs) is advocated.
• However, approximately 2000 children annually receive care in non-PICUs across Australia and New Zealand.
• This highlights a gap in accessible, specialized pediatric critical care.

Purpose of the Study:

• To identify factors influencing decisions for local care versus transfer of critically ill children.
• To assess existing infrastructure supporting local care in non-PICUs.
• To propose strategies for improving care for critically ill children in non-PICUs.

Main Methods:

• A survey was conducted among consultants from 13 non-PICUs in Australia and New Zealand.
• These units admitted over 50 children in 2002 and 2003.
• The survey focused on decision-making factors and available support infrastructure.

Main Results:

• Survey results informed a proposal to enhance care in non-PICUs.
• Key proposed elements include implementing protocols, establishing routine consultations with regional PICUs, utilizing telemedicine, and upskilling local staff.
• Evidence for these measures and for centralization was reviewed.

Conclusions:

• Critically ill children continue to be managed in non-PICUs, necessitating improved local care strategies.
• A multi-faceted approach involving protocols, expert consultation, telemedicine, and staff development can enhance care quality.
• This proposal aims to bridge the gap in specialized pediatric critical care delivery.