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Organizing and Leading a Multidisciplinary PICU

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Abstract

Pediatric critical care units (PICUs) have come a long way over the past four decades. They continue to be clinical areas that are resource-intensive. PICUs require a team of highly engaged and well-trained professionals working together to change the trajectory of critical illness. Consequently, it requires strong physician and nursing leadership to lead the team of dedicated individuals to perform at the highest level. A dyad of a PICU Medical Director and a PICU Nursing Director is a good construct for administrative leadership. Several options of models exist—open versus closed or a hybrid model. A 24 × 7 coverage of the PICU with skilled personnel is important to provide timely care but is not always possible due to personnel constraints. Indian PICUs have also evolved and made significant strides in their governance and coverage models. Policies and standard operating procedures (SOPs) govern the care that is delivered and may need to be updated regularly. The NABH reviews these as part of their accreditation process. A multidisciplinary committee structure to review aspects of PICU function and outcomes on a regular basis is vital. Certain guiding principles should determine the philosophy of the PICU, and the leaders in the PICU need to model behavior in keeping with these principles. PICU outcomes should be measured and tracked; a root-cause analysis should be triggered when appropriate; and interventions should be made using the PDSA (plan-do-study-act) cycle of process improvement when outcomes fall short of expectations. Adverse events should ideally be disclosed, but this represents a challenge in the current environment. Indian PICUs continue to evolve rapidly, and establishing a database for comparative analysis of outcomes is a natural next step.

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Acknowledgements

The authors are grateful to Drs Mahesh Mohite and Nameet Jerath, Chairperson and Secretary of the Intensive Care Chapter of the IAP, respectively, for their help in disseminating the survey to the Indian PICU community. The authors also greatly appreciate the 103 survey respondents representing Intensivists working at hospitals throughout India providing us invaluable data on behalf of their institution. Pediatric Intensivists who volunteered their names are listed in Supplementary Material S1.

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Authors and Affiliations

  1. Pediatric Critical Care, Boys Town National Research Hospital, 14000 Hospital Rd, Boys Town, NE, 68010, USA

    Mohan Ram Mysore

  2. Pediatric ICU, Apollo Children’s Hospital, Chennai, Tamil Nadu, 600006, India

    Suchitra Ranjit

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  1. Mohan Ram Mysore
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  2. Suchitra Ranjit
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Both authors have contributed to and reviewed the final manuscript prior to submission. MRM will act as the guarantor for this paper.

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Correspondence to Mohan Ram Mysore.

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Mysore, M.R., Ranjit, S. Organizing and Leading a Multidisciplinary PICU. Indian J Pediatr 90, 251–260 (2023). https://doi.org/10.1007/s12098-022-04427-2

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