Integrating Paediatric Intermediate Care Units Into Tiered Care Systems: A Narrative Review and Italian Perspective

Area of Science:

• Pediatric Healthcare Systems
• Hospital Management
• Patient Care Delivery

Background:

• Paediatric hospital care complexity is rising, with many children needing advanced monitoring.
• General ward capabilities are often insufficient for complex paediatric cases.

Purpose of the Study:

• Evaluate the role of paediatric intermediate care units (PIMCUs) in tiered paediatric care.
• Assess the organizational impact and implementation of PIMCUs, particularly in Italy.

Main Methods:

• Conducted a narrative review of studies on PIMCUs from major databases up to December 2025.
• Included paediatric and relevant adult studies on organizational and economic aspects.
• Described a specific PIMCU model implemented at the Gaslini Institute, Genoa.

Main Results:

• PIMCUs offer intermediate care for children needing enhanced monitoring and non-invasive support.
• Studies suggest PIMCUs improve patient allocation, reduce unnecessary intensive care admissions, and enhance care transitions.
• Italian context shows fragmented care due to limited intensive care capacity and lack of PIMCU recognition.
• An integrated PIMCU model improved patient flow, preserved intensive care capacity, and boosted system resilience.

Conclusions:

• Paediatric intermediate care units are crucial for acuity-based paediatric care systems.
• Implementing PIMCUs can lead to improvements in efficiency, equity, and patient safety.