More children are living longer after surviving critical illness, in part thanks to pediatric medical care improvements over the past two decades. The American Academy of Pediatrics (AAP), in an updated policy statement, describes the need to address the changes in children's hospital care. Among recommendations, the AAP highlights a need to establish pediatric intermediate care units (IMCUs).
A bridge between critical care and a general ward
IMCUs could provide more intensive monitoring and care for pediatric patients who are not critically ill, but are too sick or have medical conditions too complex for a general hospital ward.
The new policy statement, "Guidance for Structuring a Pediatric Intermediate Care Unit," is published in the May 2022 Pediatrics. A nine-member task force representing the AAP Section on Critical Care, Committee on Hospital Care, and Section on Surgery produced the policy statement, which updates recommendations last written in 2004.
In the statement, The AAP calls for hospitals or health systems to design clear, comprehensive triage guidelines for admission to and care within a pediatric IMCU, as well as making clear when children should be treated in an IMCU versus a pediatric intensive care unit. Pediatric patient populations well served by an IMCU model may include children with acute critical illness, children with complex chronic disease and a range of pediatric surgical patients.
Pediatric IMCU staff training & ratios
The AAP also observes the need for specially trained pediatric staff, care managers and social workers as well as a nurse-to-patient ratio at 1:2 or 1:3 to care for pediatric IMCU patients. The new statement is intended for institutions, administrators, providers, health care funders, and policy makers in all settings, including rural and urban hospitals and major academic centers.