The current gaps in paediatric ICU facilities in India and how one should choose the right care at the need of the hour

Dr Sanjay Swamy, Chief Paediatric Intensivist, SPARSH Hospital for Women and Children talks about the current gaps in paediatric ICU facilities in India

Paediatric Intensive Care Unit has today become an essential requirement in reducing morbidity and mortality globally. We have come a long way in establishing PICU in most of the cities as we understand the importance and timely help these units provide. There have been many instances where PICUs have been able to establish greater success rates of care and healing by providing respiratory support, neurologic protection and many such medical aids, ensuring support to the child and the family for a positive recovery from life-threatening challenges. Furthermore, PICUs also extend a learning hand to the doctors and other staff members with challenging experiences which in-turn helps in finding ways to improve the standards of care inside and outside the PICU.

While we look at the flip side of it, in India we are yet to evolve completely in terms of PICUs. We have noticed that in most of the hospitals, PICU is still at its developing stage. Though the majority of the hospitals have services that they extend towards PICU, there are very few who have designated intensive care units. From shortage of  healthcare staff trained to care for critically ill children to lack of rapid access to necessary medications, supplies and equipment, there are a number of challenges that hospitals face. Additionally, finding professionally trained staff is yet another challenge they face. It’s very important that the doctors and nurses are provided adequate training sessions and knowledge sharing to stay updated on treatment methods, advanced equipment handling techniques so that they can act on time during an emergency situation.

Let’s look at some of the obstacles

Lack of awareness

PICUs play a crucial role when a child is critically ill. It requires highly skilled staff who are trained in providing the highest level of medical care. Along with the doctors, the hospital staff and administration have to be aware about the role a PICU can play in a child’s life when he/she needs it. This understanding is currently lacking, and it’s important for hospitals to create awareness programs and initiatives to help PICU personnel to learn about the pivotal role of PICUs for children who are in need of intensive care services.

Lack of specific skilled training and funding for equipment

There is a severe shortage of skilled staff who are equipped to handle the intricacies involved in managing a PICU. Getting skilled nurses is always an ongoing problem. Once the nurses get trained, they tend to get a better job elsewhere or they move abroad for opportunities that are well paying. Additionally, funding and directing resources towards PICU is always a challenge for hospitals. When compared to adult ICUs, a PICU is sometimes not financially viable for hospitals because the volumes are much lower. Hence, directing any additional funds and resources into PICUs is always a challenge.

Shortage of workforce

Attrition rates are high when it comes to doctors and nurses who are specialised in Pediatric intensive care. Trained doctors and nurses move abroad for better opportunities and better pay. Having a healthy staffing capacity for the PICU unit who can dedicatedly attend to children without any compromise is a definitive requirement.

While access to PICU facilities is crucial, it’s also important to ensure that a child gets the required support at the right time without any delay. There are many cases that go undocumented and unattended. In most of these cases,  we see that  delayed access to care is the culprit. From  delay in identifying special conditions to delay in seeking help for the condition or reaching out to appropriate facilities, most of these are due to lack of awareness and shortage of designated ICUs with adequate number of healthcare staff trained to care for critically ill children.

A thoughtful approach to developing pediatric critical care services  starts with fundamental building blocks: training healthcare professionals in skills and knowledge, selecting resource appropriate effective equipment, and having supportive leadership to provide an enabling environment for appropriate care. If these fundamentals can be built in a sustainable manner, an appropriate critical care service will be established with the potential to significantly decrease paediatric morbidity and mortality.

It’s important for parents to have a good understanding of the hospitals and their services in and around their vicinity. It is important to understand that during any emergency even a delay by a minute could cost you a lot. Not all pediatricians are qualified to attend ICU cases. Therefore,  so do your research before you finalise on one. Please understand everyone has their own expertise and not everyone can do it all.