Pediatric Intermediate Care Units: A Bridge Between Pediatric Ward and ICU Care

Pediatric intermediate units (PIMCUs) care for high acuity and technology-dependent children who exceed the care capacities of an inpatient ward, yet do not require the resources of a PICU.1 Despite recently updated guidelines for PIMCUs, there are limited data on PIMCU structure, staffing, therapies provided, and quality measurements tracked.2 We hypothesized that PIMCUs with higher proportions of critical care-trained staff would offer higher acuity interventions. We also sought to identify outcomes tracked pertaining to safe triage. METHODS A survey was administered in 2021 to PIMCU directors in the Children’s Hospital Association (CHA) registry, excluding single subspecialty units.3 Initial sampling identified PIMCUs in acute care children’s hospitals with a PICU in the CHA directory, excluding specialty or research hospitals. PIMCU directors were identified either through outreach to PICU medical directors through the network of Pediatric Critical Care Chiefs or by contacting hospitals directly to identify the presence of a PIMCU, then identifying the associated PIMCU director.4 Identified PIMCU medical directors were emailed a 29-question survey with up to 2 reminders. The survey was administered via the REDCap (Research Electronic Data Capture) tool hosted at the authors’ institution.5 Survey items were developed with multidisciplinary consensus, drawn from existing studies when feasible, and revised with cognitive interviewing and piloting. All data were deidentified and analyzed in aggregate. PIMCU characteristics were evaluated using frequencies. Associations between demographic factors, staffing, structure, and interventions were analyzed using v2 tests and t tests for categorical and continuous responses. This study was deemed exempt from human subjects research by the authors’ institutional review board. RESULTS Responses were received from 175 out of 195 (90%) of CHA acute care pediatric hospitals in the United States and Canada. Of the 70 potential PIMCUs identified, 62 (89%) responded to the director survey, 38 PIMCUs met inclusion criteria, and 24 were excluded because of their association with a single subspecialty. © 2024 by the American Academy of Pediatrics.