A virtual pediatric intensive care unit?

There is a shortage of intensivists in the US, both pediatric ones and those who care for adults. Intensive care nurses are in short supply, too. Yet the demand for intensive care services is growing. Part of the demand for adult intensivists is driven by our aging population, but what about children? Why aren’t there enough pediatric intensivists to go around?

I think the principal reason is that our national standard of care for children has changed over the past decades. When I trained in pediatrics over 30 years ago, only the largest children’s hospitals had PICUs. That has changed. The expectation these days is that medium-sized hospitals provide a much higher level of pediatric care than they did in the past, and that includes care of critically ill or injured children. Sometimes this means having a regional transport system so that such children can be rapidly flown to a larger center. But more and more it means that we need to have PICU capability in more places, and that means we need more pediatric intensivists.

Many have wondered if part of this problem can be solved by spreading the expertise of intensivists over a wider area, by taking advantage of all the communication and monitoring capability we have — that is, by establishing what has been labeled a “virtual ICU.” The idea has been gaining ground in adult practice; here is an example of what it means.

How could that work? What most people mean by a virtual ICU is that intensive care doctors (or nurses) can sit in a room and monitor the vital signs, lab results, x-rays, etc., of patients in ICUs in another location. The monitoring doctor could see the patients with a video camera, too. The patients aren’t alone, of course — there are doctors and nurses at the bedside, just not intensivists. When the intensivist monitoring the situation spots something, or if the doctor on site needs advice, there’s the telephone.

Can this work? I have a friend who is an adult intensivist and who has done this for years. He’s enthusiastic about the concept. I’m not so sure about children, though. Maybe I’m a dinosaur, but there’s a fair amount of research that shows that the best way of determining if a child is really, really sick is to have an experienced person say that child is sick. Tests and monitors help, but the sixth sense that an experienced person brings to the bedside is invaluable.

Still, I think some version of virtual ICUs are in the future for children, too. The technology does keep improving, and we simply don’t have enough pediatric intensivists to go around. Looking at the number of pediatricians training to become intensivists, this situation isn’t going to change anytime soon.

The concept of a virtual PICU can also have another role — that of intensivists exchanging information and collaborating with each other. Children’s Hospital of Los Angeles has been running a site intended to do that for several years now.


3 responses to “A virtual pediatric intensive care unit?”

  1. […] and Mayo Foundation. But aside from caring for children seeking intensive care, Johnson is also a blogger and author of several parenting books, including “How to Talk to Your Child’s Doctor: A Handbook for […]

  2. Vanessa Jamieon Avatar
    Vanessa Jamieon

    Good afternoon. I am a young high school student and i’m 16 years old. i have always wanted to be able to help the community and help sick or hurting people. It has been my life long dream to become a pediatrician. I love children and being involved. Can anyone help me by telling me a good college to attend for this particular major? Thank You.

  3. Hi Vanessa:

    I’m glad to hear you’re interested in pediatrics. All the surveys show that pediatricians have the highest job satisfaction among all doctors. It’s easy to see why.

    You can go to medical school after you’ve earned a 4 year undergraduate degree — BA or BS. You apply in the fall of your senior year and also take a standard test called the Medical College Admission Test (MCAT). I think the best way to choose a college or university is to ask them when you visit how many students from that institution successfully get into medical school each year and if they have a premedical adviser or office that helps and advises students with the process. It’s tough to do it all on your own. That’s the bottom line — how many folks got into medical school. In general, the more competitive, higher ranked academically colleges do better at that than others. They also prepare their students better for the MCAT.

    A few colleges and universities have what they call a premedical major, but the great majority do not — you just major in a field as any other student. These days most students going to medical school major in one of the sciences, such as biology or chemistry, but that is not required. (I majored in history and religion, for example). But no matter what you major in you need to take the prerequisite courses for medical school. This varies a little from medical school to medical school, but it usually amounts to 2 years of chemistry (including organic chemistry or biochemistry), a year of biology, a year of physics, and a year of math at the calculus level.

    Good luck. We’re always looking for good people.

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