PICU MIC: Integrated care in pediatric/neonatal intensive care units around the world

Pediatric palliative care (PPC) is a human right and, in many cases, a foundational component of the best available standard of care. Across the world, PPC is not adequately available in a variety of clinical environments, including in many pediatric and neonatal intensive care units (PICUs/NICUs). While PPC is most popularly integrated into such units through consultative models of care in which external teams are called to address PPC needs as they are identified, integrative models of care (IMOC) also exist in which ICU personnel identify and address PPC needs within the unit as they arise. The less common IMOC may be uniquely beneficial in its ability to facilitate the delivery of care to special needs patients, maximize available resources, build local PPC capacity, and make PC available in under-resourced environments. Building international PC capacity and integrating the IMOC into PICUs/NICUs depend upon a chain of interventions like The Initiative for Pediatric Palliative Care (IPPC) guidelines, which outline six domains of quality PPC. The objective of this multicenter study was to assess how different PICU/NICU centers around the world currently implement an IMOC of PPC and pediatric critical care in relation to the IPPC recommendations. In addition, this study sought to identify whether the physical environment, technological infrastructure, and human resources of each unit may shape the provision and outcomes of care in relation to IPPC guidelines.