Key points are not available for this paper at this time.
ObjectiveS: The 2019 American Academy of Pediatrics recommendations for PICU and pediatric cardiac ICU (PCICUs) staffing are that it include intensivists, advanced practice providers (APPs), medical trainees, nurses, respiratory therapists (RTs), and pharmacy consultation. We have examined interprofessional staffing in U.S. pediatric critical care units in 2022–2023. Design: Secondary analysis of 2022–2023 data from a national survey of ICUs merged with the 2019 American Hospital Association database. We compared tertiary and quaternary unit staffing. Setting: U.S. tertiary and quaternary PICUs/PCICUs in 2022–2023. Patients: Pediatric patients. Interventions: None. Measurements and Main Results: We included 49 PICUs/PCICUs (11 tertiary, 38 quaternary) across 26 states: 19 of 49 were in children’s hospitals, all were teaching hospitals, and 24 of 49 were considered “large” (16–30 beds). Intensivists were available in 48 of 49 units: onsite 24-hr/d in 37 of 49, worked 7 consecutive days in 32 of 49, and had no other clinical responsibilities during pediatric critical care service in 36 of 49. APPs (31/49), fellows (38/49), and residents (44/49) were available in many units. Nurses were assigned to care for one patient receiving mechanical ventilation in 21 of 49 units or two patients in 26 of 49 units. For noninvasive mechanical ventilation, a ratio of one nurse to two patients was most common (45/49). In 48 of 49 units RTs were available on all shifts. Pharmacists participated in care during weekday shifts in 44 of 49 units. Pharmacists participated in care on weeknights in 18 of 49 units, on weekend days in 29 of 49 units, and on weekend nights in 16 of 49 units. Compared with tertiary units, quaternary unit practice was associated with having more of the following: 24-hour intensivist coverage, APPs, fellows, and residents, RTs throughout all shifts, and more RTs without responsibilities outside the ICU throughout all shifts ( p < 0.05 for all). Conclusions: In this 2022–2023 national sample, pediatric intensivists, APPs, registered nurses, pharmacists, and RTs were available to care for critically ill children. Intensivist, APP, and RT staffing varied by PICU level.
Arciprete et al. (Mon,) studied this question.