The workings of a hospital can be a bit of a mystery to patients. Parents particularly are interested about what’s going on when their child is admitted into an intensive care unit.

Kristi Ryan, RN, Nurse Manager for the Pediatric Cardiac Intensive Care Unit, and Ira Cheifetz, MD, Chief of the Division of Critical Care Medicine, describe how the unit at Duke Children’s Hospital & Health Center functions and answer common questions parents ask.

-- Dennis Clements MD, PhD, MPH

Ira Cheifetz, MDThe Pediatric Intensive Care Unit (PICU) at Duke Children’s Hospital provides comprehensive services for a wide variety of critically ill medical and surgical patients with acute, life-threatening disease and injury.

When infants or children become critically ill, require complex surgery, or are in need of very close medical attention for any reason, our PICU is available to them.

Medical and surgical subspecialists from all disciplines are immediately available. Our specialty trained professionals and highly technological equipment allow for some of the sickest children in the country to be cared for at Duke.

Located in Zone 5600 on the fifth floor of Duke University Hospital, the PICU is a state-of-the-art critical care unit designed to meet the needs of our patients and families. Duke Children’s currently has 20 total pediatric intensive care beds and will expand to 29 beds in late 2008 with the opening of our new Pediatric Cardiac Intensive Care Unit.

Most of the rooms are shared with another patient. However, there are four single rooms that are generally reserved for patients who have a compromised immune system.

Below are some frequently asked questions about the PICU.

What can I expect when my child is admitted?

Whether it is a planned admission or an emergency, when your child first arrives in the PICU he or she is examined by a team of physicians, nurses, and respiratory therapists.

During this time, information will be gathered to help determine your child’s plan of care. We require that you wait in the waiting room during this time, or leave a number where you can be reached. We realize how difficult this separation is for both you and your child.

Once your child has been assessed, someone from the health care team will come and explain your child’s current plan of care and bring you into the PICU to be with your child.

When will I be able to visit my child?

Families are encouraged to spend as much time as possible with their child. Our busiest  hours are 6:45 a.m. - 9:30 a.m. and 6:45 p.m. - 8 p.m. due to change of shift report and rounds. During this time you will be asked to step out of the unit.

There may also be other times during the day that you will be asked to step out of the unit or wait to visit your child. This may occur because we are admitting another patient to an adjacent bed space or performing a procedure. We regret any inconvenience this may cause and really appreciate your cooperation.

We ask that no more than two visitors at a time be at your child’s bedside. Parents may visit throughout the day and night. Daytime visitation may include family and close friends at the discretion of the parents. Nighttime visiting (after 9 p.m.) will be limited to parents/guardians or their designee. After 9 p.m., please obtain an overnight sticker from the unit coordinator (HUC) to wear for security reasons. Siblings are welcome to visit if it is acceptable to the parents/guardians.

What happens in the PICU during a day?

The PICU nurses provide care during twelve-hour shifts. The day shift is from 6:45 a.m. to 6:45 p.m.; night shift from 6:45 p.m. to 6:45 a.m. The nurses give each other reports about your child’s needs and care at the beginning of each shift. Nurses in the PICU may have one or two patients to care for during their shifts.

Every morning from 7:30 a.m. to approximately 10:30 a.m., the PICU health care team makes detailed rounds on each patient. Every patient is discussed to review the events of the previous day and to determine the plan for the upcoming day. Doctors, nurse practitioners, patient care nurses, respiratory therapist, dietitians, pharmacists, and social workers attend these rounds.

It may be overwhelming at first to meet all of the people who are taking care of your child, but each member of the team is working together to provide for all of your child’s needs. During the course of the day, the doctors and nurse practitioners will make every effort to speak with you and review your child’s progress and plans for the day.

During the day, new patients may be admitted to the PICU following surgery and procedures. We also perform many procedures directly in the PICU. You may be asked to step out of the unit briefly for either of these reasons. Your child’s nurse will continue to monitor your child during that time, and we will always do our best to keep you informed.

When you are with your child in the PICU, you will see many different monitors and hear various alarms. The alarms may seem overwhelming, but your child’s nurse can explain what the alarms mean. Sometimes the alarms will ring because your child is moving or the nurse has interrupted the monitor. If you have any questions about an alarm or any other equipment, please ask your child’s nurse.

Who will be taking care of my child?

The PICU is made up of a variety of health care professionals working together as a team in order to provide the best care possible. You will meet many people here, and we expect that you may not remember everyone’s name. Please do not hesitate to ask one of us to re-introduce ourselves or our role in your child’s care.

Here are just a few of the people that will be involved in the care of your child:

• Attending physicians: senior members of the medical and/or surgical staff who are in charge of your child’s care. The attendings supervise your child’s treatment and work with other team members to plan care every day.
• Fellows: physicians who have completed their residency and are now training in a specialty area of pediatrics.
• Pediatric nurse practitioner (NP): work with the physician team in the PICU. They are nurses who have completed specialized training to care for critically ill children.
• Residents: physicians who are receiving advanced training in the hospital. They rotate through the PICU for approximately one month.
• Registered nurse (RN): PICU nurses are specially educated in caring for critically ill children and their families.
• Respiratory therapist (RT): evaluates and treats patients with breathing problems. This person assists with a child’s care by providing therapy and education during the hospital stay.
• Pharmacist: assists the medical and surgical teams with decisions regarding medications, intravenous fluids, and intravenous nutrition. 
• Nutritionist:  assists the medical and surgical teams with providing appropriate nutrition for  critically ill children. 

How can I help keep my child safe?

Safety is one of our biggest priorities in the PICU. We encourage you to participate in helping us keep your child safe. Here are a few things that you can do to help keep them safe:

• Wash your hands. Children in the PICU are at great risk of infection because they are already ill. All people entering the PICU must wash their hands every time they enter the unit. If a visitor has a cold or other infectious disease, they may not be allowed to visit the PICU.
• Identification. Double check your child’s identification band. ID bands must be worn at all times. Let your nurse know if your child does not have one or if it comes off. Check that caregivers use the ID band. They are required to check both the child’s name and medical record number before administering medication, performing procedures or transfusing blood.

-- Kristi Ryan, RN, is Nurse Manager for the Pediatric Cardiac Intensive Care Unit.

-- Ira Cheifetz, MD, is chief of the Division of Critical Care Medicine,

-- Dennis Clements, MD, PhD, MPH, is the chief of primary care pediatrics at Duke Children's Hospital.