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

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.