The state of the unit: variable care models in paediatric acute care cardiology units documented by the fourth iteration of the Paediatric Acute Care Cardiology Collaborative (PAC³) Hospital Survey

Background: Pediatric acute care cardiology is a distinct subspecialty field within paediatric cardiology that has grown rapidly in recognition, with previously documented heterogeneity in its practice across 31 centres surveyed in 2017. Unit composition and care delivery across centres participating in the Paediatric Acute Care Cardiology Collaborative (PAC³) have not been formally reassessed and shared, despite significant growth in the field. Methods: A 214-stem question Hospital Survey was created with 454 total response fields across eight domains important to paediatric acute care cardiology such a demographics, staffing, resources and therapies, and standard practices. PAC³ centres were surveyed in September 2023 via REDCap. Descriptive statistics were performed. Results: Surveys were completed by 100% (47/47) of PAC³ centers. Diverse unit composition exists with 37% of centres utilising a single, dedicated acute care cardiology unit, 28% using mixed-specialty acute care units, and 19% using acuity adaptable units, housing critical and acute care patients in one physical space. Since 2017, acute care cardiology-dedicated multidisciplinary staff has increased (physical therapy (PT): 0 to 4; occupational therapy (OT): 1 to 5; speech-language pathology (SLP): 0 to 4; PharmD: 7 to 26). There is heterogeneity in utilisation of many of the resources and therapies used in acute care cardiology, and use of ventricular assist devices on the acute care cardiology unit has increased. Conclusion: Significant variability exists in unit structure and care delivery models across a diverse group of centres providing acute care cardiology services.