To explore international PICU long term outcome services and practical management strategies

Key Findings: ICU Liberation is a key element to improving long term outcomes and should be adapted and implemented in the PICU as a standard of care. Liberation and long-term outcome activities need to go hand in hand. All centres are struggling to determine which outcome measures should be used. PICU cares for a heterogenous population of varying ages and disease processes. Researchers and clinicians struggle with the subjective nature of parent completed reports or the resource intensive nature of face-to-face assessments. Parents are often unwilling to return to the hospital following critical illness for intensive face-to-face assessments, creating further challenges with missing data and prolonged engagement. Clinics for clinical or research purposes are frequently coordinated and accessed centrally and pose a challenge for regional and rural families. A limitation of the US health care system is that care is provided across various fractured healthcare systems. As a result, there is limited ability to coordinate a nationwide registry of PICU care and outcomes. Australia and New Zealand are very fortunate to have a single healthcare system and a binational PICU registry, with 95-98% capture of all children admitted to an ICU in the region. This registry is subsequently used for epidemiological, benchmarking and research purposes. The current limitation of the Australian and New Zealand Paediatric Intensive Care Registry is the documentation of a single outcome: mortality. It is becoming increasingly acknowledged worldwide, that morbidity outcomes are important to assess impact of care on survivorship. We have a unique opportunity within Australia to expand the current registry or develop a parallel, linked registry of outcomes addressing post-PICU morbidity. Children are frequently discharged into the care of a paediatrician in the US, a practice which is different in Australia. Paediatricians offer a unique perspective into child development compared to general practitioners. In Australia, children are routinely discharged back into the care of their local general practitioner, who may have minimal paediatric exposure and training. There is a potentially a gap in the knowledge and skills of general practitioners in caring for a child following critical illness. There are a handful of paediatric rehabilitation facilities providing sub-acute traditional care which allows the patient to be discharged from the PICU sooner and into care with a play/home philosophy. I am not aware of any such stand-alone facilities in Australia which have a philosophy of care which is quite distinct from hospital care.  The benefits of Pet Therapy in educational and healthcare settings is not new. Pet therapy provides significant physical and mental health benefits, in addition to encouraging movement and improving recovery. Many PICUs use pet therapy for patients, family and staff alike.   Keywords: Paediatric Intensive Care Unit (PICU), Post Intensive Care Syndrome in Paediatrics (PICS-p), liberation, ABCDEF Bundle, THRIVE, mortality, morbidity, neurodevelopment