Academic Journal
View in EDS
Linked Full Text

Integrating Paediatric Intermediate Care Units Into Tiered Care Systems: A Narrative Review and Italian Perspective.

Bibliographic Details
Title: Integrating Paediatric Intermediate Care Units Into Tiered Care Systems: A Narrative Review and Italian Perspective.
Authors: Brisca G; Neonatal and Pediatric Intensive Care Unit, Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy., Pirlo D; Neonatal and Pediatric Intensive Care Unit, Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy., Romanengo M; Neonatal and Pediatric Intensive Care Unit, Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy., Moscatelli A; Neonatal and Pediatric Intensive Care Unit, Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
Source: Acta paediatrica (Oslo, Norway : 1992) [Acta Paediatr] 2026 Sep; Vol. 115 (9), pp. 1872-1877. Date of Electronic Publication: 2026 May 28.
Publication Type: Journal Article; Review
Language: English
Journal Info: Publisher: Wiley-Blackwell Country of Publication: Norway NLM ID: 9205968 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1651-2227 (Electronic) Linking ISSN: 08035253 NLM ISO Abbreviation: Acta Paediatr Subsets: MEDLINE
Imprint Name(s): Publication: 2007- : Oslo : Wiley-Blackwell
Original Publication: Oslo : Scandinavian University Press, c1992-
MeSH Terms: Intermediate Care Facilities*/organization & administration , Hospitals, Pediatric*/organization & administration, Humans ; Italy ; Child ; Pediatrics
Abstract: Aim: Paediatric hospital care has become increasingly complex with many children requiring monitoring and support beyond general ward capabilities. This review evaluated the role of paediatric intermediate care units (PIMCUs) within tiered paediatric care systems, with a focus on organizational impact and implementation in Italy.
Methods: We conducted a narrative review using PubMed, Embase, Scopus and the Cochrane Library up to 31 December 2025. Studies addressing PIMCUs were included, together with selected adult studies on organizational and economic aspects. The PIMCU model at the Gaslini Institute in Genoa, Italy, was also described.
Results: PIMCUs provided intermediate care for children requiring enhanced monitoring and noninvasive support without full intensive care. Paediatric studies suggested improved patient allocation, reduced inappropriate intensive care admissions and safer transitions of care, findings supported by adult literature with potential cost-effectiveness. In Italy, limited intensive care capacity, regional disparities and lack of formal recognition of PIMCUs contributed to fragmented care pathways. The model developed by our Institute showed that an integrated PIMCU within a hub-and-spoke network improved patient flow, preserved intensive care capacity and enhanced system resilience.
Conclusions: PIMCUs are key components of acuity-based paediatric care systems. Their implementation may improve efficiency, equity and patient safety.
(© 2026 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)
References: Crit Care. 2025 Jan 20;29(1):34. (PMID: 39833886)
JBI Evid Implement. 2025 Oct 24;:. (PMID: 41128160)
Hosp Pediatr. 2020 Apr;10(4):347-352. (PMID: 32220935)
Crit Care. 2025 Apr 23;29(1):157. (PMID: 40269982)
Acta Paediatr. 2020 May;109(5):1062-1063. (PMID: 31730257)
Hosp Pediatr. 2019 Jul;9(7):538-544. (PMID: 31253646)
Crit Care Med. 2020 Jul;48(7):946-953. (PMID: 32317594)
Indian J Pediatr. 2025 Feb;92(2):150-156. (PMID: 37971648)
Crit Care Med. 2020 Jan;48(1):64-72. (PMID: 31609775)
JAMA Intern Med. 2025 Jul 1;185(7):757-759. (PMID: 40423960)
Hosp Pediatr. 2024 Jul 1;14(7):e317-e320. (PMID: 38867703)
Crit Care Med. 2026 Feb 1;54(2):234-245. (PMID: 41217377)
Front Pediatr. 2025 Apr 09;13:1539540. (PMID: 40270943)
Pediatr Crit Care Med. 2025 Apr 1;26(4):e585-e587. (PMID: 39898765)
Pediatr Pulmonol. 2023 Mar;58(3):918-926. (PMID: 36510441)
Arch Dis Child. 2014 Jul;99(7):652-8. (PMID: 24686043)
J Crit Care. 2017 Oct;41:268-274. (PMID: 28601043)
Pediatrics. 2004 May;113(5):1430-3. (PMID: 15121967)
Intensive Care Med. 2010 Aug;36(8):1403-9. (PMID: 20490781)
Am J Emerg Med. 2023 Feb;64:169-173. (PMID: 36563501)
Lancet. 2021 Dec 11;398(10317):2193-2206. (PMID: 34695372)
Arch Dis Child. 2020 Feb;105(2):173-179. (PMID: 31401558)
J Clin Med. 2025 Sep 10;14(18):. (PMID: 41010602)
J Clin Med. 2025 Sep 17;14(18):. (PMID: 41010747)
Crit Care. 2008;12(3):R68. (PMID: 18482443)
Eur J Pediatr. 2026 Feb 16;185(3):134. (PMID: 41699321)
Crit Care. 2014 Oct 09;18(5):551. (PMID: 25664865)
Lancet. 2023 Oct 28;402(10412):1525. (PMID: 37898527)
Pediatrics. 2022 May 1;149(5):. (PMID: 35490284)
Contributed Indexing: Keywords: acuity‐aligned care; healthcare organization; high‐dependency unit; paediatric critical care networks; paediatric intermediate care unit
Entry Date(s): Date Created: 20260528 Date Completed: 20260811 Latest Revision: 20260813
Update Code: 20260813
PubMed Central ID: PMC13460445
DOI: 10.1111/apa.70608
PMID: 42207648
Database: MEDLINE
FullText Links:
  – Type: other
    Url: https://resolver.ebsco.com:443/public/rma-ftfapi/ejs/direct?AccessToken=43A3A24B3AA213E8094E&Show=Object
Text:
  Availability: 0
Header DbId: cmedm
DbLabel: MEDLINE
An: 42207648
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Integrating Paediatric Intermediate Care Units Into Tiered Care Systems: A Narrative Review and Italian Perspective.
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AU" term="%22Brisca+G%22">Brisca G</searchLink>; Neonatal and Pediatric Intensive Care Unit, Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.<br /><searchLink fieldCode="AU" term="%22Pirlo+D%22">Pirlo D</searchLink>; Neonatal and Pediatric Intensive Care Unit, Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.<br /><searchLink fieldCode="AU" term="%22Romanengo+M%22">Romanengo M</searchLink>; Neonatal and Pediatric Intensive Care Unit, Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.<br /><searchLink fieldCode="AU" term="%22Moscatelli+A%22">Moscatelli A</searchLink>; Neonatal and Pediatric Intensive Care Unit, Intermediate Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="JN" term="%229205968%22">Acta paediatrica (Oslo, Norway : 1992)</searchLink> [Acta Paediatr] 2026 Sep; Vol. 115 (9), pp. 1872-1877. <i>Date of Electronic Publication: </i>2026 May 28.
– Name: TypePub
  Label: Publication Type
  Group: TypPub
  Data: Journal Article; Review
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: TitleSource
  Label: Journal Info
  Group: Src
  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Wiley-Blackwell%22">Wiley-Blackwell </searchLink><i>Country of Publication: </i>Norway <i>NLM ID: </i>9205968 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>1651-2227 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2208035253%22">08035253 </searchLink><i>NLM ISO Abbreviation: </i>Acta Paediatr <i>Subsets: </i>MEDLINE
– Name: PublisherInfo
  Label: Imprint Name(s)
  Group: PubInfo
  Data: <i>Publication</i>: 2007- : Oslo : Wiley-Blackwell<br /><i>Original Publication</i>: Oslo : Scandinavian University Press, c1992-
– Name: SubjectMESH
  Label: MeSH Terms
  Group: Su
  Data: <searchLink fieldCode="MM" term="%22Intermediate+Care+Facilities%22">Intermediate Care Facilities*</searchLink>/<searchLink fieldCode="MM" term="%22Intermediate+Care+Facilities+organization+%26+administration%22">organization & administration</searchLink> <br /><searchLink fieldCode="MM" term="%22Hospitals%2C+Pediatric%22">Hospitals, Pediatric*</searchLink>/<searchLink fieldCode="MM" term="%22Hospitals%2C+Pediatric+organization+%26+administration%22">organization & administration</searchLink><br /><searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Italy%22">Italy</searchLink> ; <searchLink fieldCode="MH" term="%22Child%22">Child</searchLink> ; <searchLink fieldCode="MH" term="%22Pediatrics%22">Pediatrics</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Aim: Paediatric hospital care has become increasingly complex with many children requiring monitoring and support beyond general ward capabilities. This review evaluated the role of paediatric intermediate care units (PIMCUs) within tiered paediatric care systems, with a focus on organizational impact and implementation in Italy.<br />Methods: We conducted a narrative review using PubMed, Embase, Scopus and the Cochrane Library up to 31 December 2025. Studies addressing PIMCUs were included, together with selected adult studies on organizational and economic aspects. The PIMCU model at the Gaslini Institute in Genoa, Italy, was also described.<br />Results: PIMCUs provided intermediate care for children requiring enhanced monitoring and noninvasive support without full intensive care. Paediatric studies suggested improved patient allocation, reduced inappropriate intensive care admissions and safer transitions of care, findings supported by adult literature with potential cost-effectiveness. In Italy, limited intensive care capacity, regional disparities and lack of formal recognition of PIMCUs contributed to fragmented care pathways. The model developed by our Institute showed that an integrated PIMCU within a hub-and-spoke network improved patient flow, preserved intensive care capacity and enhanced system resilience.<br />Conclusions: PIMCUs are key components of acuity-based paediatric care systems. Their implementation may improve efficiency, equity and patient safety.<br /> (© 2026 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)
– Name: Ref
  Label: References
  Group: RefInfo
  Data: Crit Care. 2025 Jan 20;29(1):34. (PMID: <searchLink fieldCode="PM" term="%2239833886%22">39833886)</searchLink><br />JBI Evid Implement. 2025 Oct 24;:. (PMID: <searchLink fieldCode="PM" term="%2241128160%22">41128160)</searchLink><br />Hosp Pediatr. 2020 Apr;10(4):347-352. (PMID: <searchLink fieldCode="PM" term="%2232220935%22">32220935)</searchLink><br />Crit Care. 2025 Apr 23;29(1):157. (PMID: <searchLink fieldCode="PM" term="%2240269982%22">40269982)</searchLink><br />Acta Paediatr. 2020 May;109(5):1062-1063. (PMID: <searchLink fieldCode="PM" term="%2231730257%22">31730257)</searchLink><br />Hosp Pediatr. 2019 Jul;9(7):538-544. (PMID: <searchLink fieldCode="PM" term="%2231253646%22">31253646)</searchLink><br />Crit Care Med. 2020 Jul;48(7):946-953. (PMID: <searchLink fieldCode="PM" term="%2232317594%22">32317594)</searchLink><br />Indian J Pediatr. 2025 Feb;92(2):150-156. (PMID: <searchLink fieldCode="PM" term="%2237971648%22">37971648)</searchLink><br />Crit Care Med. 2020 Jan;48(1):64-72. (PMID: <searchLink fieldCode="PM" term="%2231609775%22">31609775)</searchLink><br />JAMA Intern Med. 2025 Jul 1;185(7):757-759. (PMID: <searchLink fieldCode="PM" term="%2240423960%22">40423960)</searchLink><br />Hosp Pediatr. 2024 Jul 1;14(7):e317-e320. (PMID: <searchLink fieldCode="PM" term="%2238867703%22">38867703)</searchLink><br />Crit Care Med. 2026 Feb 1;54(2):234-245. (PMID: <searchLink fieldCode="PM" term="%2241217377%22">41217377)</searchLink><br />Front Pediatr. 2025 Apr 09;13:1539540. (PMID: <searchLink fieldCode="PM" term="%2240270943%22">40270943)</searchLink><br />Pediatr Crit Care Med. 2025 Apr 1;26(4):e585-e587. (PMID: <searchLink fieldCode="PM" term="%2239898765%22">39898765)</searchLink><br />Pediatr Pulmonol. 2023 Mar;58(3):918-926. (PMID: <searchLink fieldCode="PM" term="%2236510441%22">36510441)</searchLink><br />Arch Dis Child. 2014 Jul;99(7):652-8. (PMID: <searchLink fieldCode="PM" term="%2224686043%22">24686043)</searchLink><br />J Crit Care. 2017 Oct;41:268-274. (PMID: <searchLink fieldCode="PM" term="%2228601043%22">28601043)</searchLink><br />Pediatrics. 2004 May;113(5):1430-3. (PMID: <searchLink fieldCode="PM" term="%2215121967%22">15121967)</searchLink><br />Intensive Care Med. 2010 Aug;36(8):1403-9. (PMID: <searchLink fieldCode="PM" term="%2220490781%22">20490781)</searchLink><br />Am J Emerg Med. 2023 Feb;64:169-173. (PMID: <searchLink fieldCode="PM" term="%2236563501%22">36563501)</searchLink><br />Lancet. 2021 Dec 11;398(10317):2193-2206. (PMID: <searchLink fieldCode="PM" term="%2234695372%22">34695372)</searchLink><br />Arch Dis Child. 2020 Feb;105(2):173-179. (PMID: <searchLink fieldCode="PM" term="%2231401558%22">31401558)</searchLink><br />J Clin Med. 2025 Sep 10;14(18):. (PMID: <searchLink fieldCode="PM" term="%2241010602%22">41010602)</searchLink><br />J Clin Med. 2025 Sep 17;14(18):. (PMID: <searchLink fieldCode="PM" term="%2241010747%22">41010747)</searchLink><br />Crit Care. 2008;12(3):R68. (PMID: <searchLink fieldCode="PM" term="%2218482443%22">18482443)</searchLink><br />Eur J Pediatr. 2026 Feb 16;185(3):134. (PMID: <searchLink fieldCode="PM" term="%2241699321%22">41699321)</searchLink><br />Crit Care. 2014 Oct 09;18(5):551. (PMID: <searchLink fieldCode="PM" term="%2225664865%22">25664865)</searchLink><br />Lancet. 2023 Oct 28;402(10412):1525. (PMID: <searchLink fieldCode="PM" term="%2237898527%22">37898527)</searchLink><br />Pediatrics. 2022 May 1;149(5):. (PMID: <searchLink fieldCode="PM" term="%2235490284%22">35490284)</searchLink>
– Name: SubjectMinor
  Label: Contributed Indexing
  Group:
  Data: <i>Keywords: </i>acuity‐aligned care; healthcare organization; high‐dependency unit; paediatric critical care networks; paediatric intermediate care unit
– Name: DateEntry
  Label: Entry Date(s)
  Group: Date
  Data: <i>Date Created: </i>20260528 <i>Date Completed: </i>20260811 <i>Latest Revision: </i>20260813
– Name: DateUpdate
  Label: Update Code
  Group: Date
  Data: 20260813
– Name: PubmedCentralID
  Label: PubMed Central ID
  Group: ID
  Data: PMC13460445
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/apa.70608
– Name: AN
  Label: PMID
  Group: ID
  Data: 42207648
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=cmedm&AN=42207648
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/apa.70608
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        StartPage: 1872
    Subjects:
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Italy
        Type: general
      – SubjectFull: Child
        Type: general
      – SubjectFull: Pediatrics
        Type: general
      – SubjectFull: Intermediate Care Facilities organization & administration
        Type: general
      – SubjectFull: Hospitals, Pediatric organization & administration
        Type: general
    Titles:
      – TitleFull: Integrating Paediatric Intermediate Care Units Into Tiered Care Systems: A Narrative Review and Italian Perspective.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Brisca G
      – PersonEntity:
          Name:
            NameFull: Pirlo D
      – PersonEntity:
          Name:
            NameFull: Romanengo M
      – PersonEntity:
          Name:
            NameFull: Moscatelli A
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 09
              Text: 2026 Sep
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-electronic
              Value: 1651-2227
          Numbering:
            – Type: volume
              Value: 115
            – Type: issue
              Value: 9
          Titles:
            – TitleFull: Acta paediatrica (Oslo, Norway : 1992)
              Type: main
ResultId 1