I was recently called by a friend who works in an adult ICU. He had been rotating in our pediatric ICU few years ago:

– “Hi Javi, sorry to call you during work hours but a colleague from the ICU is having a terrible time. Her daughter is awaiting surgery at your hospital but it has been cancelled again and again for lack of beds. What can I tell her?”

– “Hello. I would love to be able to help, I understand her frustration. But it does not depend on us. We only have 11 PICU beds and a very ambitious surgical program. The priority of patients who are operated is decided on a surgical board, but many times there are more programmed patients than beds available. The pressure on the beds is very strong. “

-” Oh, really? But bronchiolitis season is already over, right? “

– “Right. But we are still overbooked. Plans are made during the winter to expand the unit but then the summer comes and they are forgotten.”

– “And is there anything that can be done?”

– “Yes, we are sometimes forced to make quick fixes, but it may be detrimental to patients. 2, 4 or 6 month-old children have been admitted to the neonatal unit. Other times, older children, who have recently undergone a scoliosis surgical repair, have been transferred from the operating room to the adult ICU by ambulance, across the street, and other patients have been referred to other hospitals. “

– “And … how are you coping with it?”

– “Well, bad. Surgeons are desperate because they do not know the provision of beds. Anesthesiologists ask us every morning whether patients can be put to sleep. There is a lot of tension, and we end up having conflicts with other service partners. “

“And what does your boss say?”

– “Well, he has presented many projects, he has requested an intermediate care unit in many occasions, but all his proposals have been rejected. And now he has resigned because not only the hospital leadership does not offer a solution to this problem but has come to decide which patients must be admitted to the PICU without his approval (by giving green light to scheduled non-urgent surgeries that occupy the emergency bed, leaving the PICU without the emergency bed for days). It’s a shame that 40 years of service and relationship with the hospital should end like this, but  in this way he has given us all an example of coherence. “

“And what does the hospital manager say?”

– “We wrote her a letter and she even came to listen to us. She acknowledged that we have a problem but she told us that the creation of an intermediate care unit or the extension of the PICU was not a priority and there was no budget. “

-“C’mon! They must have done something…! “.

– “Well, instead of that they reformed a postanesthetic recovery unit to try to improve the waiting list for minor surgeries but it is still not working. This unit cannot be used for children who need intensive care, chronic patients with special healthcare needs or patients with acute medical (non-surgical) conditions .”

“And how do you think this problem could be solved?”

– “An intermediate care unit would be ideal because you can include short postoperative care as well as chronic patients after surgical or medical conditions.

– “Well, cheer up, ok?”

– “Thank you. Cheer your friend up too. “

Do you have a bed available in the PICU?

No, but we have a 24-hour open visitation policy PICU (even before Proyecto HU-CI started), and music therapists, teachers, volunteers and clowns to make the children happier.

And we take the patients for a walk around the unit when we can.

And we have a portable DVD per bed.

And auxiliaries and nurses who give them drawings, crafts and play with them Parcheesi.

I’m glad … but is there a bed?

No, but we have asked for a consultation to be able to attend the post-ICU syndrome and not just see the patients in the corridor, but it has been denied to us.

Fantastic … but do you have a bed?

No. But we are the most appreciated section by pediatric residents.

And when are you going to have a bed?

I do not know … but: would you help us to have it?

Javier Urbano Villaescusa, MD, PhD on behalf of PICU, Hospital General Universitario Gregorio Marañón. Madrid, Spain.