Photo of Dr. Parsapour
Parsapour uses telemedicine to oversee medication delivery for an Oroville-area infant. Photograph courtesy of the Davis Enterprise, Alison Portello.

Posted Apr. 11, 2007

Earlier this year, when two-month old Jeremiah Cervantes-Bone couldn't possibly get enough air into his tiny, pneumonia-laden lungs, the emergency team in the Northern California town of Oroville turned to a pediatric critical care specialist at UC Davis Children's Hospital in Sacramento.

Connected from 90 miles away via a video-conferencing link known as telemedicine, pediatric critical care specialist Kourosh Parsapour was able to see Jeremiah's extremely critical breathing problems and provide crucial advice that helped stabilize the child so he could be transported to UC Davis for specialty care, where he responded well to treatment and is now back home with his parents.

Jeremiah's recovery from a potentially life-threatening condition is a testament to the expertise of the pediatric critical care team at UC Davis and the well-coordinated efforts of health-care professionals throughout the region who partner with UC Davis every day.

"We see children in this unit who are the most critically ill and are frequently struggling between life and death," said Anthony Philipps, medical director of UC Davis Children's Hospital and chair of the Department of Pediatrics. "Thanks to a highly skilled team of doctors, nurses, therapists, pediatric transport specialists, most of our patients do get to go home to their families. It's those types of outcomes that keep us focused on providing the best possible care."

Monitoring quality of care

One way the UC Davis pediatric intensive care (PICU) team assesses its performance is by comparison with other leading pediatric intensive care units around the country. For the past seven years, the PICU at UC Davis Children's Hospital has been in the top six among 33 units that use the Pediatric Risk of Mortality (PRISM) program, a national standard used for quantifying performance at a number of children's hospitals. PRISM data shows that while youngsters admitted to UC Davis are sicker (85 percent of admissions are emergency cases), they are more likely to survive their illness or injury than those admitted to most of the other PICUs in the sample.

Pediatric ICU Evaluations (PICUEs) software was developed by Children's National Medical Center in Washington, D.C. It measures physiologic variables such as blood pressure, heart and respiratory rate, blood oxygen and carbon dioxide levels, and pupil response, and adjusts for severity of illness to predict mortality in a PICU. A number of pediatric organizations around the country, including all of the intensive care units for children in California, use this benchmarking data to estimate outcomes and assess performance as compared to peer hospitals.

"Performance benchmarks are an important way to regularly measure and constantly improve levels of care, which helps explain why we do so well in saving the lives of such critically ill children," said James Marcin, a critical care specialist who tracks the unit's performance and prepared this year's PICU data.

Providing round-the-clock care

UC Davis' pediatric intensive care unit is specifically designed for severely ill infants and children up to the age of 18 years. Last year, 1,020 children were admitted to the unit. Typical admissions include children needing surgery for congenital heart disease or those suffering from traumatic injuries or pneumonia.

Photo of Dr. Pretzlaff with pediatric patient
Chief of pediatric critical care medicine, Robert Pretzlaff, checks on a young patient in the Pediatric Intensive Care Unit at UC Davis Children's Hospital.

The PICU is led by Chief of Pediatric Critical Care Medicine Robert Pretzlaff and Nurse Manager Laura Kenney. It provides round-the-clock care for patients, with attending physicians managing all care, along with at least one registered nurse assigned to every one to two patients at all times.

The unit serves much of Northern California, providing critical care service both at the hospital and via the high-speed video connections of telemedicine that connect UC Davis physicians to distant communities that don't have the same volume of pediatric emergencies as a major academic medical center. Since early 2000, UC Davis has provided pediatric emergency consultations via telemedicine to communities ranging from Oroville and Willits to Fallon, Nevada.

UC Davis Children's Hospital is a designated by the National Association of Children's Hospitals and Related Institutions. The hospital provides a comprehensive range of inpatient and outpatient service, including the only level I pediatric trauma and emergency service in a 33-county region