The safety issues affecting children in intensive care: A blog by Peter Sidgwick

Summary

hub topic lead, Peter Sidgwick, consultant in the Paediatric Intensive Care Unit (PICU) and Associate Medical Director at Great Ormond Street Hospital, reflects on working in PICU and highlights some of the risks. He discusses the safety measures in place that mitigate these risks and keep children as safe as possible while they are in PICU.

This blog is part of our World Patient Safety Day 2025 series - Safe care for every newborn and every child.

Content

A resident doctor at the end of their rotation through the PICU where I worked asked me how I can keep coming back to such a high-stakes, high-risk job, day in, day out. At the time, I didn’t have a ready answer—I think I told them that I loved what I did, and that was enough. That answer still holds true, but I now know that this passion is only sustainable because I understand and have confidence in the systems that surround me and my team, which keep our patients as safe as possible while they are in our care.

Risks in PICU

There are lots of reasons that risks are high in PICU—the list makes a sobering read. Our patients’ clinical condition can change within minutes, they can’t always communicate their needs and their care often involves complex, high-risk interventions. Their unique anatomy and physiology—smaller airways, faster metabolic rates and narrower margins for error—mean that clinical deterioration can be swift and severe. Seemingly minor missteps in airway management, fluid balance or medication calculation can have significant negative consequences.

Protocols and technology

Protocolised practice and technology go a long way to mitigating these risks. As an example, the risk of medication errors is high in PICU, largely due to the need for weight-based calculations, the absence of standard dosing for many drugs and the fact that many of our patients are dependent on several medications to sustain life. Solutions to the risk that surrounds this include double-checks for high-alert medications, standardised concentrations, smart infusion technology with built-in dose limits and electronic prescribing with clinical decision support.

Structured safety tools—such as pre-procedure briefings, closed-loop communication, and checklists—are proven to reduce errors. Similarly, care bundles for prevention of ventilator associated pneumonia and central line associated blood stream infections, and early rehabilitation and mobilisation bundles to ensure quick recovery from critical illness, all ensure that the harm accrued by our patients due to the therapies we use is as low as it can possibly be.

A positive safety culture

However, protocols and technology can only take a team so far, and the risks we see in PICU are not fully mitigated by these. The most sophisticated equipment is only as safe as the team operating it. Communication failures, unclear role allocation and cognitive overload remain significant contributors to patient safety incidents. As is so often true in life, the quality and maturity of the relationships within and across all members of the team affects how well the team functions. At it’s best, that team function and culture allows an environment in which every team member, regardless of seniority, feels empowered to speak up and participate in reflection upon and learning from a potential risk or actual patient safety incident.

With a positive safety culture, regular incident reporting becomes the norm, debriefing after critical events feels safe not threatening, and mortality and morbidity discussions become focused on deep learning and achieving real improvement for the next patient.

Family and carer involvement

There are two other teams that contribute in untold ways to safety in PICU—our patients' families and carers, and the systems and organisations with whom we benchmark our clinical outcomes.

The overwhelming majority of patients in PICU have loved ones looking out for them—focused on their monitors, their subtle signs and signals of recovery or deterioration and willing them better.

Family and carer engagement is a super-power in PICU—a voice of advocacy, an interpreter and a crucial reminder of the human at the centre of the tubes, wires, pumps and machines.

Properly curated activity, risk and performance data and the benchmarking of clinical outcomes that it allows may be less ‘human’ than family and carers, but it is critical in helping the team know where their practice falls in relation to their peers. Signals, acted upon early, allow improvement or evolution of clinical practice when patients are experiencing harm that may not be visible in an individual patient's story but becomes clear when a sufficiently well-organised data set is analysed.

In PICU safety is not just a checklist—it’s an ongoing, team-wide commitment to vigilance, precision and adaptability.

Our patients’ resilience is remarkable, but it is our responsibility to ensure the environment around them is as safe as possible. And when they are safe, I can feel safe in my practice and keep coming back to do the job I love.

About the Author

Peter is a consultant in the Paediatric Intensive Care Unit (PICU) at Great Ormond Street Hospital (GOSH), where he is also Co-Associate Medical Director for Safety. He has experience of clinical and operational leadership roles at GOSH and the North Thames Paediatric Network and is an Associate Adviser with NHS Resolution. As safety lead at GOSH, Peter is committed to leading a team delivering patient safety expertise founded on rigour, compassion and curiosity as embedded within the PSIRF principals. 

Peter maintains a full clinical practice in PICU, including retrieval medicine, and believes strongly that keeping patients safe through their complex care journeys requires each and every team member to understand and participate in the patient safety processes at every step.