Children’s Critical Care Medicine is at a crucial point in its history. Following three decades of progress, wide variability remains in the quality of pediatric critical care practiced throughout this country. This arises from the isolated and urgent nature of critical care practice.

In general, critical care is provided in the setting of a large, pressing clinical work load managed by a small number of intensivists at any single location. These practitioners develop close relationships and similar practices. They develop their own distinct "unit" style.

No single intensivist or group sees sufficiently large numbers of patients with any particular illness to prospectively determine the best medical practice. Pediatric critical care medicine is practiced in isolated, scattered centers of varying quality with poor communication. Academic Centers of excellence also practice in isolation. Their "cutting edge" practice often remains unchallenged and unshared.