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Integrating Paediatric Intermediate Care Units Into Tiered Care Systems: A Narrative Review and Italian Perspective
Giacomo Brisca1, Daniela Pirlo1, Marta Romanengo1
1Neonatal and Pediatric Intensive Care Unit, Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Insights
Paediatric intermediate care units (PIMCUs) enhance patient flow and safety in complex hospital settings. Implementing PIMCUs improves efficiency and equity in paediatric care systems.
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.
Aim:
Paediatric hospital care has become increasingly complex with many children requiring monitoring and support beyond general ward capabilities. This review evaluated the role of paediatric intermediate care units (PIMCUs) within tiered paediatric care systems, with a focus on organizational impact and implementation in Italy.
Methods:
We conducted a narrative review using PubMed, Embase, Scopus and the Cochrane Library up to 31 December 2025. Studies addressing PIMCUs were included, together with selected adult studies on organizational and economic aspects. The PIMCU model at the Gaslini Institute in Genoa, Italy, was also described.
Results:
PIMCUs provided intermediate care for children requiring enhanced monitoring and noninvasive support without full intensive care. Paediatric studies suggested improved patient allocation, reduced inappropriate intensive care admissions and safer transitions of care, findings supported by adult literature with potential cost-effectiveness. In Italy, limited intensive care capacity, regional disparities and lack of formal recognition of PIMCUs contributed to fragmented care pathways. The model developed by our Institute showed that an integrated PIMCU within a hub-and-spoke network improved patient flow, preserved intensive care capacity and enhanced system resilience.
Conclusions:
PIMCUs are key components of acuity-based paediatric care systems. Their implementation may improve efficiency, equity and patient safety.
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