Pediatric Cardiac Intensive Care Distribution, Service Delivery, and Staffing in the United States in 2018*

Abstract

Objectives: To assess the distribution, service delivery, and staffing of pediatric cardiac intensive care in the United States. Design: Based on a 2016 national PICU survey, and verified through online searching and clinician networking, medical centers were identified with a separate cardiac ICU or mixed ICU. These centers were sent a structured web-based survey up to four times, with follow-up by mail and phone for nonresponders. Setting: Cardiac ICUs were defined as specialized units, specifically for the treatment of children with life-threatening primary cardiac conditions. Mixed ICUs were defined as separate units, specifically for the treatment of children with life-threatening conditions, including primary cardiac disease. Participants: Cardiac ICU or mixed ICU physician medical directors or designees. Measurements and Main Results: One-hundred twenty ICUs were identified: 61 (51%) were mixed ICUs and 59 (49%) were cardiac ICUs. Seventy five percent of institutions at least sometimes used a neonatal ICU prior to surgery. The most common temporary cardiac support beyond extracorporeal membrane oxygenation was a centrifugal pump such as Centrimag. Durable cardiac support devices were far more common in separate cardiac ICUs (84% vs 20%; p < 0.0001). Significantly less availability of electrophysiology, heart failure, and cardiac anesthesia consultation was available in mixed ICUs (p = 0.0003, p < 0.0001, p = 0.042 respectively). ICU attending physicians were in-house day and night 98% of the time in mixed ICUs and 87% of the time in cardiac ICUs. Nurse practitioners were consistent front-line providers in the ICUs caring for children with primary cardiac disease staffing 88% of cardiac ICUs and 56% of mixed ICUs. Mixed ICUs were more commonly staffed with pediatric residents, and critical care fellows were found in more cardiac ICUs (83% vs 77%; p < 0.0001). Conclusions: Mixed ICUs and cardiac ICUs have statistically different staffing models and available services. More evaluation is needed to understand how this may impact patient outcomes and training programs of physicians and nurses.

Establishing Entrustable Professional Activities in Pediatric Cardiac Critical Care*

“…The majority of survey respondents were from dedicated CICUs, with a smaller proportion (17.2%) practicing at mixed PICUs that deliver cardiac care. Although there are some differences between these ICUs and dedicated CICUs in services offered, there are sufficient similarities in the care of cardiac patients in these units to suggest that the same PCCC EPAs apply to training and practice in mixed PICUs (17). In addition, any study dependent on voluntary participation is prone to selection bias, and people with stronger opinions may be more likely to respond.…”

Sharing and learning through the Pediatric Cardiac Critical Care Consortium: Moving toward precision care

“…It is noteworthy that predictive data analytics are used in less than 20% of pediatric cardiac ICUs. 24 In this era of ubiquitous electronic healthcare records and emerging methods for capturing high-frequency physiologic data, 25 this is a deficiency. Time-series continuous physiologic data generated from patients in the operating room, ICU, and ward settings must be captured and stored permanently; analysis will allow better understanding of physiologic states and risks for an event within that state.…”

Simulation as an Educational Tool in the Pediatric Cardiac Intensive Care Unit

“…Differences in the makeup of PCICU teams also extend to the front-line. Depending on the graduate medical education institutional footprint, front-line providers may range from advanced practice providers to residents and/or fellows [ 16 ]. Each staffing model has a distinct background and perspective resulting in differences in continuity of care and baseline knowledge.…”