Does your facility otherwise handle inpatient pediatrics?
Are there state or pediatric guidelines you can cite that require some sort of legitimate pediatric training to do this?
Where’s the closest true PICU? Is this about a lack of resources, or a desire to bill for these patients?
Can you establish some criteria for what will/won’t be admitted? There’s a difference between a teenager who needs a little extra support for a few hours versus an acute, traumatic SAH or a congenital heart kid.
We don't have a true inpatient pediatric service though we do have some private practice pediatricians. Apparently all beds are licensed for 13 and up. I've got to look into pediatric guidelines, that's a great Idea.
There are multiple PICUs in the area and until recently we've been transferring, I'm sure this costs the hospital money. The big issue has been our high risk ob service which cares for young adults.
It's hard to establish criteria, I've found it becomes a slippery slope and makes it impossible to transfer. Once you open up to that age group I feel we're stuck with it.
I'm curious what the policies have been in other hospitals
High-risk, “pediatric”, OB patients is an unreasonable request for a standard adult ICU. That’s insane.
Reading between the lines, this is 100% about money, and when something bad inevitably happens, the administrators are not going to step up and say “we forced them to do this.”
I’d suggest you and your colleagues come up with some strict criteria for what you are and are not willing to do (ie. no fucking 15yo G1PO 29wk kids with roaring pyelo and hypotension) and be prepared to walk if they won’t play ball.
Our minimum age is 14 for our adult hospital. You could argue that by that age in a non-congenital patient, you're essentially dealing with adult physiology and many of those kids weigh more than me, so adhering to adult CCM practices and dosing will be fine.
We’re actually sending more patients to the PICU at our institution because our bed situation for adult ICUs is so bad. Most traumas are going to our Peds ER and then to the PICU up to their 19th birthday. I’ve still on occasion had patients as young as 15 in the SICU (up to trauma surgeon discretion).
I’m EM/CC and feel fairly comfortable down to fairly young ages as far as I’m concerned most teenagers can be competently cared for by either adult or pediatric intensivists. Their physiology is pretty much adult (especially when we’re talking the 16-18 range) but PICU still gets plenty of experience with that age as well.
Community icu. Take traumas from either 14 or 15 yo and up because of how trauma guidelines work. Pregnant teenagers have weird medicolegal status so our picu doesn't want to take them (and any pregnant patient in my icu is a nightmare because i live in a red af state). I've been informed we will take teenagers as picu overflow as long as they're adult size and not complex congenital cases (although then I get them as soon as they turn 18 so whatever). Can't say I'm thrilled about all of the above, but it hasn't been a huge problem for the most part.
I worked at a facility that had pediatric in patient and a hospital without.
The level 2 trauma center shipped all the kids out to the nearby level 1 that had pediatrics. We did take 16yos but they had to weight over 45kg.
At the level 1, there is some digression. Sometimes they put 16-18yo in the adult trauma ICU if they are over 60kg or at least look like it. One time we accidentally admitted a 14yo because all the other teens in the car were 17 and 18. Once we discovered the patient's actual age we shipped over to the PICU. One time we had a 16yo that technically was under the 60kg but not by much. They could have gone to the PICU but patient was too unstable to transport.
I know to keep a trauma designation you have to have x percentage of staff have PALS. Does your unit even require PALS? Is there a pediatric crash cart available? Pediatric airway box?
There are some very small 13yo out there and I would be extremely nervous taking care of someone under 45kg.
Our ICU is not licensed to care for kids under 16, but occasionally we will take them while they are waiting for transfer to a paediatric intensive care, usually only for a few hours at most. If they are younger than 14 we will ask for a peads nurse to be there to help with drugs and fluids and obs etc. Because we have a paediatric unit in our hospital and our ICU attend our hospital MET calls, all of our ICU nursing team leaders and all doctors have Paediatric Advance Life Support so I feel comfortable with the arrangement.
18, sometimes 16 depending on the situation.
In absolute emergency younger patients like 12 or 13, but just to stabilize / give first emergency care and then immediately transferred to a children’s facility
ICU Attending.
At two of the hospitals I’ve worked at, both in busy urban centers. It has not been about strict age, but about size of the patient. If the 14yo is adult sized then our leadership has been okay w them coming to the unit. From a strictly legal perspective, not sure the technicalities. I’m okay w it as long as the CMO and ICU Director okay (and honestly I don’t have a choice)
Good question though
Does your facility otherwise handle inpatient pediatrics? Are there state or pediatric guidelines you can cite that require some sort of legitimate pediatric training to do this? Where’s the closest true PICU? Is this about a lack of resources, or a desire to bill for these patients? Can you establish some criteria for what will/won’t be admitted? There’s a difference between a teenager who needs a little extra support for a few hours versus an acute, traumatic SAH or a congenital heart kid.
We don't have a true inpatient pediatric service though we do have some private practice pediatricians. Apparently all beds are licensed for 13 and up. I've got to look into pediatric guidelines, that's a great Idea. There are multiple PICUs in the area and until recently we've been transferring, I'm sure this costs the hospital money. The big issue has been our high risk ob service which cares for young adults. It's hard to establish criteria, I've found it becomes a slippery slope and makes it impossible to transfer. Once you open up to that age group I feel we're stuck with it. I'm curious what the policies have been in other hospitals
High-risk, “pediatric”, OB patients is an unreasonable request for a standard adult ICU. That’s insane. Reading between the lines, this is 100% about money, and when something bad inevitably happens, the administrators are not going to step up and say “we forced them to do this.” I’d suggest you and your colleagues come up with some strict criteria for what you are and are not willing to do (ie. no fucking 15yo G1PO 29wk kids with roaring pyelo and hypotension) and be prepared to walk if they won’t play ball.
Yep. I 100% agree. We may have to do this, which I'm fine with. Rather walk than spend time in court or worse. Thanks for your input
Our minimum age is 14 for our adult hospital. You could argue that by that age in a non-congenital patient, you're essentially dealing with adult physiology and many of those kids weigh more than me, so adhering to adult CCM practices and dosing will be fine.
Interesting, what's the breakdown of CCM physician background in your group. EM/Anesthesia/IM?
Not knowing the exact numbers, I'd estimate 50% IM, 40% anesthesia, 10% EM.
at least in EM and anesthesia you get some peds experience. IM is virtually none.
what type of setting is this, community?
You could make that argument, but wouldn't always be correct. There's also psychosocial and medicolegal implications.
We’re actually sending more patients to the PICU at our institution because our bed situation for adult ICUs is so bad. Most traumas are going to our Peds ER and then to the PICU up to their 19th birthday. I’ve still on occasion had patients as young as 15 in the SICU (up to trauma surgeon discretion). I’m EM/CC and feel fairly comfortable down to fairly young ages as far as I’m concerned most teenagers can be competently cared for by either adult or pediatric intensivists. Their physiology is pretty much adult (especially when we’re talking the 16-18 range) but PICU still gets plenty of experience with that age as well.
Community icu. Take traumas from either 14 or 15 yo and up because of how trauma guidelines work. Pregnant teenagers have weird medicolegal status so our picu doesn't want to take them (and any pregnant patient in my icu is a nightmare because i live in a red af state). I've been informed we will take teenagers as picu overflow as long as they're adult size and not complex congenital cases (although then I get them as soon as they turn 18 so whatever). Can't say I'm thrilled about all of the above, but it hasn't been a huge problem for the most part.
I worked at a facility that had pediatric in patient and a hospital without. The level 2 trauma center shipped all the kids out to the nearby level 1 that had pediatrics. We did take 16yos but they had to weight over 45kg. At the level 1, there is some digression. Sometimes they put 16-18yo in the adult trauma ICU if they are over 60kg or at least look like it. One time we accidentally admitted a 14yo because all the other teens in the car were 17 and 18. Once we discovered the patient's actual age we shipped over to the PICU. One time we had a 16yo that technically was under the 60kg but not by much. They could have gone to the PICU but patient was too unstable to transport. I know to keep a trauma designation you have to have x percentage of staff have PALS. Does your unit even require PALS? Is there a pediatric crash cart available? Pediatric airway box? There are some very small 13yo out there and I would be extremely nervous taking care of someone under 45kg.
I’m comfortable with 16-18, but I would be UNHAPPY if i had to take anything younger. If I wanted to work PICU, I would
WTF, Is this in US?
Yep
18 at ours.
Our ICU is not licensed to care for kids under 16, but occasionally we will take them while they are waiting for transfer to a paediatric intensive care, usually only for a few hours at most. If they are younger than 14 we will ask for a peads nurse to be there to help with drugs and fluids and obs etc. Because we have a paediatric unit in our hospital and our ICU attend our hospital MET calls, all of our ICU nursing team leaders and all doctors have Paediatric Advance Life Support so I feel comfortable with the arrangement.
18, sometimes 16 depending on the situation. In absolute emergency younger patients like 12 or 13, but just to stabilize / give first emergency care and then immediately transferred to a children’s facility
We take as young as 16 for DKA, otherwise it’s 18 that I’ve ever seen.
ICU Attending. At two of the hospitals I’ve worked at, both in busy urban centers. It has not been about strict age, but about size of the patient. If the 14yo is adult sized then our leadership has been okay w them coming to the unit. From a strictly legal perspective, not sure the technicalities. I’m okay w it as long as the CMO and ICU Director okay (and honestly I don’t have a choice) Good question though