3701-84-61 Pediatric intensive care service standards.

(A) The provisions of rules 3701-84-61 to 3701-84-65 of the Administrative Code are applicable to each provider of a pediatric intensive care service (PICU) services regardless of the date service was initiated.

(B) Each provider of a PICU service shall develop and follow written comprehensive and effective patient care policies and procedures that designate the severity of illnesses that may be treated and the types of care that may be provided in the PICU. The PICU shall operate within the scope of this service plan.

(C) A temporary expansion of PICU services due to seasonal illness or outbreak necessitating an increase in the number of PICU beds does not require notification to the director under the change in the scope of the HCS requirement set forth in paragraph (G) of rule 3701-84-04 of the Administrative Code. Any expansion of PICU services for these purposes shall meet all established requirements for a PICU.

(D) Each provider of a PICU service shall require that the a pediatric intensivist or the pediatric intensivist's designee be available in thirty minutes or less, on a twenty-four hour a day basis.

(E) The following physicians shall be available to the PICU in less than sixty minutes on a twenty-four hour a day, seven days a week basis:

(1) An anesthesiologist with demonstrated training and experience in pediatrics ;

(2) A pediatric surgeon or a general surgeon with demonstrated training and experience in pediatrics;

(3) Pediatric subspecialists to include:

(a) A pediatric critical care medicine physician (intensivist);

(b) A cardiologist;

(c) A nephrologist;

(d) A hematologist/oncologist;

(e) A gastroenterologist;

(f) An endocrinologist;

(g) A pulmonologist;

(h) An infectious disease specialist; and(i) A neurologist;

(4) Surgeon subspecialists with demonstrated training and experience in pediatrics, to include:

(a) A neurosurgeon ;

(b) An otolaryngologist ;

(c) A craniofacial (plastic) surgeon;

(d) An oral surgeon;

(e) An orthopedist; and

(f) A cardiovascular surgeon.

(5) A radiologist with demonstrated training and experience in pediatrics;

(6) A pathologist with demonstrated training and experience in pediatrics; and

(7) A psychiatrist or psychologist with demonstrated training and experience in pediatrics.

(F) Each provider of a PICU service shall have access to the following pediatric specialists for consultation and treatment as necessary, either on staff or by arrangement or contract:

(1) A neonatologist;

(2) An allergist or immunologist; and

(3) A geneticist.

(G) Each provider of a PICU service without an on-site pediatric cardiovascular surgery service shall maintain a written transfer agreement for emergency pediatric cardiovascular surgery services with a provider of pediatric cardiovascular surgery services that can be reached expeditiously from the catheterization laboratory or angiography suite, required in paragraph (M)(2) of this rule, by available emergency vehicle in less than sixty minutes on a twenty-four hour a day, seven days a week basis and that provides the greatest assurance for patient safety.

(H) Each provider of a PICU service shall have available at least two operating rooms with the capability, equipment and personnel to perform emergency procedures in less than sixty minutes on a twenty-four hour a day, seven days a week basis.

(I) Each provider of a PICU service shall have access to a blood bank with all blood components available twenty-four hours a day, seven days a week. Unless some unusual antibody is encountered, blood typing and cross matching shall allow for transfusion in less than sixty minutes.

(J) Each provider of the PICU service shall have radiology services available at all times to the PICU to meet the needs of the patient and shall include:

(1) Portable radiology;

(2) Fluoroscopy;

(3) Computerized tomography scanning;

(4) Ultrasonography;

(5) Angiography;

(6) Nuclear scanning; and

(7) Magnetic resonance imaging;

(K) Radiation therapy services shall be available on-site or through contract with another hospital.

(L) Each provider of a PICU service shall have the following clinical laboratory capabilities:

(1) Microspecimen capability and one hour turnaround time for:

(a) Clotting studies and measurements of complete blood cell count;

(b) Differential count;

(c) Platelet count;

(d) Urinalysis;

(e) Electrolytes;

(f) Blood urea nitrogen;

(g) Creatinine;

(h) Glucose;

(i) Calcium;

(j) Prothrombin time;

(k) Partial thromboplastin time; and

(l) Cerebrospinal fluid cell counts;

(2) Blood gas values available within fifteen minutes;

(3) Within three hours, results of:

(a) Drug screening and levels of serum ammonia;

(b) Serum and urine osmolarity;

(c) Phosphorus; and

(d) Magnesium.

(4) Preparation of gram stains and bacteriological cultures available twenty-four hours a day, seven days a week.

(M) Each provider of a PICU service shall have access to the hospital's pharmacy service and personnel on-site capable of dispensing all necessary medications for pediatric patients of all types and ages, twenty-four hours a day, seven days a week.

(N) Diagnostic cardiac and neurological services shall be available twenty-four hours per day to the provider of a PICU service as needed and technicians with special training in pediatrics should be available to perform the following studies:

(1) Electrocardiograms, two-dimensional and echocardiograms and electroencephalograms ;

(2) A catheterization laboratory or angiography suite ; and

(3) Doppler ultrasonograph devices and evoked potential monitoring equipment.

(O) Each provider of a PICU service shall timely provide hemodialysis equipment and competent and qualified staff experienced with pediatric patients available twenty-four hours a day, seven days a week .

(P) Each provider of a PICU service shall have an integrated communication system with a local emergency medical transport system.

(Q) Each provider of a PICU service shall have a secondary emergency communication system available twenty-four hours a day, seven days a week into the PICU.

(R) Each provider of a PICU service shall have an internal transportation system and competent and qualified staff for effective transport.

(S) Each provider of a PICU service shall maintain a communication link to a federal, state, or local poison control center.

(T) A PICU shall only be operated in a fully permanent setting within the permanent frame of the building of a registered hospital that is classified as a general hospital or a children's hospital. The hospital shall be fully equipped to meet the needs of the PICU.

Effective: 8/1/2017
Five Year Review (FYR) Dates: 02/27/2017 and 03/01/2022
Promulgated Under: 119.03
Statutory Authority: 3702.11, 3702.13
Rule Amplifies: 3701.11, 3702.12, 3702.13 , 3702.14, 3702.141, 3702.15, 3702.16, 3702.18, 3702.19, 3702.20
Prior Effective Dates: 3/1/1997, 3/24/03, 5/15/08, 6/21/12