Advances in Pediatric Intensive Care Have Greatly Improved Health Outcomes
Having a child in the hospital is a frightening experience—especially when they’re suffering from a life-threatening illness or injury. However, with advances in pediatric intensive care, a child’s probability of survival has greatly improved. Jorge Gutierrez, M.D., works in pediatric critical care medicine for Kaiser Permanente, treating babies, children, and teens with extreme and life-threatening illnesses and injuries.
Tell me a little about your practice.
I’m the Assistant Physician in Chief for Pediatric Services at Kaiser Permanente Oakland Medical Center as well as one of the Pediatric ICU (PICU) physicians. Our focus in the PICU is on critically ill or injured children, ranging from newborns to teenagers, sometimes caring for young people until they’re 21 years old.
How does an intensive pediatric care practice differ from general pediatric care?
In the PICU, we care for the extremes of common diseases or injuries, which result in critical illness. Most children can be treated as outpatients by their general pediatricians, or, on a hospital ward by a pediatric hospitalist. It is when the disease process makes the child critically ill that they require treatment by the specialized team in the PICU. As an example, a child with pneumonia may be treated as an outpatient by their pediatrician, but when their pneumonia becomes so severe that it causes respiratory failure and the need to be on a respirator, they would be cared for in the PICU by our specialized team.
We also understand that it takes an entire team to care for children with serious illness or injury. Our multidisciplinary team of PICU dedicated doctors who are present around the clock, nurses and other specialists including, social workers, pediatric pharmacists, child life therapists, physical therapists, and pediatric dieticians all work together to ensure great outcomes.
We are very family focused. Our multidisciplinary team approach includes the parents—and other family members—who we encourage to participate in daily rounds and in the decision-making process. If their needs are not being met, we want to know. Families are invited to take part in our rounds so they can hear how the medical team is approaching their child’s care, and provide them with a thorough understanding of how we’ll get their child back to health. In the past 20 years, I’ve only had two families who didn’t feel comfortable with this model.
When we initially converted to this methodology, which is called Family Centered Multidisciplinary Care, we were able to demonstrate significant improvements in our outcomes and have continued to use this model ever since.
Our dedicated PICU staff includes social workers and child life specialists to provide support to the patient, their parents, and siblings as well. It’s imperative that families feel comfortable and involved. We provide lots of support during a very scary time in people’s lives.
How has intensive pediatric care changed in the past decade?
Pediatric Intensive Care has become more specialized. Beginning in the 1970s we began to see a shift toward pediatric intensive care. Massachusetts General Hospital in Boston was one of the first hospitals to create a dedicated PICU. Up until then, children and adults were often treated in the same intensive care units.
Historically the ICU doctors cared for patients during the day, and turned care over to the hospitalists at night. Today, our PICU provides 24/7 care with a dedicated team of Pediatric ICU doctors, nurses and other specially trained pediatric medical professionals.
What happens when a child requires intensive pediatric care?
Kaiser Permanente Medical Center in Oakland is one of three PICUs in the Kaiser Permanente Northern California region. We serve an area as far north as Santa Rosa and as far south as Hayward. When children need critical care, they are transferred to one of our three PICUs. We have a specialized Pediatric Critical Care Transport Team that is trained to transport critically ill children to our facility. We have created a Children’s Center with all the Pediatric Specialties, both medical and surgical, to support critically ill children. This has been one of the advantages of consolidating the care at our larger facilities such as the Oakland Medical Center, to effectively create a center that has most of the services one would find at a large children’s hospital.
What are some common misconceptions about intensive pediatric care?
The biggest is that a patient might not make it. Outcomes in Pediatric ICUs have continued to improve nationally and mortality is now under 3%. Our mortality rate in our PICU is now under 1%. These numbers are much better than outcomes in adult ICUs which has probably led to some of this misconception.
What motivates you to work in pediatric intensive care?
It’s incredibly hard, and incredibly rewarding at the same time. We are meeting families at the worst time of their lives, and we can’t save every child, but 99% of the time we have a good outcome. There’s nothing more gratifying than receiving a card or graduation picture from a child whom we cared for when they were critically ill or injured, who’s now on their way to college. It’s these types of success stories that keep me going back to work every day.
Kaiser Permanente, kp.org