Children’s Pediatric Intensive Care Unit (PICU) and Cardiac Intensive Care Unit (CICU) represent epicenters for a number of high-profile Children’s programs, including the Heart Center, Seattle Cancer Care Alliance, solid-organ transplantation, neurosurgery, craniofacial surgery, hematology-oncology, Airlift Northwest and a range of extracorporeal life-support technologies.
The trauma PICU at Harborview is the only Level 1 Pediatric Trauma Center PICU in the WWAMI region. With a “right care right now” attitude, 23 PCCM faculty and 10 PCCM fellows oversee all care in the pediatric ICUs. Several crucial concepts first evolved within Children’s ICUs, including family-centered care, formal quality-improvement and patient-safety initiatives, computerized physician order entry, severity-of-illness risk-adjusted outcomes analyses, decision-support tools that facilitate patient flow through the ICUs, and innovative infection-control programs. ICU graduates are now assessed longitudinally for health-related quality of life. Children’s ICUs received a design award from the Society of Critical Care Medicine and the American Institute of Architecture and serve as a family-friendly safe haven for critically ill children in the WWAMI region.
PCCM faculty are involved in clinical, research, teaching and administrative activities within the Department of Pediatrics, Seattle Children’s Hospital, and at Harborview Medical Center and the University of Washington. Continuous Performance Improvement initiatives focus on cost, delivery, safety and quality. Despite the very high clinical intensity involved in fellowship training, PCCM fellows all participate in basic, translational-clinical or outcomes research with an expectation of an academic career following fellowship training. The PCCM fellowship is an ACGME-accredited, three-year program with nine Seattle Children’s–funded positions. Fellows divide their clinical time between Children’s PICU and CICU and the Harborview Medical Center PICU; they provide the lead role in directing the care of all infants and children while providing supervision and education for pediatric, emergency medicine and anesthesia residents on rotation.
Major areas of research for PCCM faculty include patient safety/continuous quality improvement, pulmonary ventilation-perfusion matching, innate immunity in critical illness, cardiac mechanical-assist support, applied gene therapy, acute lung injury and repair, critical asthma therapy, in vivo intracellular oxygen transport and consumption, computerized decision-support tools, disaster preparedness and clinically meaningful long-term outcome measures following pediatric critical illness. PCCM faculty participate in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN), the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Research Network and the Pharmacology of Pediatric Drugs Group.
Ongoing administrative initiatives include implementation of 24/7 PCCM in-house service by attending staff, satellite PICU, rapid-response team development, extracorporeal life-support implementation during cardiopulmonary resuscitation and transport, standardized sedation/analgesia and mechanical ventilation decision-support tools, NACHRI bloodstream infection reduction initiative and PICU/CICU continuous quality improvement implementing a lean-focus value stream methodology.