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Paediatric Intensive Care Unit (PICU)

PICU Victoria Network

  • Introduction

    Much has changed since the 1990s when an ultra-centralised model of Paediatric Intensive Care was considered to be ideal.

    • Changing population demands (small hospitals now serve large population catchment areas)
    • Changing epidemiology – greater predominance of chronic illness, long-stay ICU, greater complexity
    • Changing treatments (e.g. non-invasive CPAP, many children on home respiratory support, High Flow)
    • Changing structures (e.g. more full-time staff in regional hospitals)
    • Particular increase in 2 populations: acute (e.g. high flow) and the chronic (e.g. neurodevelopment on NIV) that has meant more referrals to RCH and more bed days needed in RCH ICU.

    In reconsidering the State-wide PICU services, each hospital will need to consider the models that is appropriate for them in their current situation and looking to the next 5 years.  The context are diverse.  Models will include some regional hospitals having 2 or more dedicated PICU beds in their ICU.  Some regional hospitals having greater HDU capacity in their paediatrics ward.

    Quality will be enhanced by standardisation and links.

    PICU Victoria Network was formed in 2017 to support regional and outer metropolitan hospitals to increase their capacity for managing moderately unwell children, needing high dependency care or short-term ICU care.  The expected outcomes:

    • Improved systems, capacity and confidence among hospitals to manage seriously ill children, with local paediatric teams working closely with adult ICUs and emergency departments
    • PICU beds created in regional hospitals 
    • more effective emergency care, resuscitation and referral of the most critically ill children
    • more timely identification of the deteriorating patient on wards and more timely intervention (such as admission to ICU, referral to PIPER)
    • fewer unnecessary transfers by PIPER (children transferred but just sitting in RCH ED, or getting a bed on the ward, where ICU and subspecialty input is not needed)
    • more children managed closer to home by their community paediatrician in conjunction with their ICU
    • back transfers from RCH PICU to enable more experience in managing moderately sick children, have families closer to home and reduce bed pressure on RCH ICU

    To do this we need standards, training and good communication.  This PICU Victoria Network website will house standard guidelines on the care of seriously ill children, and standards for PICU equipment relevant to regional hospitals.  We will post training opportunities through PIPER Education and RCH PICU Nursing Education.  We will foster communication for hospitals involved in the Network and encourage development of services.  We will provide a liaison PICU consultant for each hospital, to be a point of contact, and as a group we will meet annually.

    Standards

    Clinical guidelines

    RCH PICU Guidelines 2017
         (Download pdf or the App)
    ITunes (Apple)
    Google play (Android)

    Criteria for paediatric admission to adult ICU or HDU in children's ward

    Piper Paediatric GO NOW Criteria

    Criteria for early identification of severe sepsis and referral to ICU

    Equipment guidelines

    Paediatric equipment for General ICUs

    Paediatric ICU data reporting

    ANZPIC Data Registry

    Training opportunities

    PIPER Paediatric ‘Situation Critical’ education in 2018

    When
    Friday, 20 April
    Friday, 26 Oct
    Friday, 23 Nov

    Content of program
    Full day program around stabilisation prior to retrieval, including procedural skills around airway, vascular access and chest drain insertion.

    Where
    Royal Children’s Hospital

    Cost
    Nursing - $180
    Medical – Fellows/Registrars/ Trainees/Students - $180
    Medical- Consultants/ GPs - $310


    Clinical ALERTS

    Respiratory infections and empyema


    Contacts at RCH PICU

    Trevor Duke, Head of General intensive care
    trevor.duke@rch.org.au

    Chris James, Co-director PIPER Paediatric
    christopher.james@rch.org.au

    Sile Smith, PIPER Paediatric Education
    sile.smith@rch.org.au

    Rob Henning, Equipment liaison
    robert.henning@rch.org.au

    Kim Morris, Nursing Education
    Kim.morris@rch.org.au

    Johnny Millar, Head of Cardiac intensive care and ANZPIC Registry liaison
    johnny.millar@rch.org.au