Direct observation of bed utilization in the pediatric intensive care unit

Abstract

BACKGROUND:The pediatric intensive care unit (PICU), with limited number of beds and resource‐intensive services, is a key component of patient flow. Because the PICU is a crossroads for many patients, transfer or discharge delays can negatively impact a patient's clinical status and efficiency.OBJECTIVE:The objective of this study was to describe, using direct observation, PICU bed utilization.METHODS:We conducted a real‐time, prospective observational study in a convenience sample of days in the PICU of an urban, tertiary‐care children's hospital.RESULTS:Among 824 observed hours, 19,887 bed‐hours were recorded, with 82% being for critical care services and 18% for non–critical care services. Fourteen activities accounted for 95% of bed‐hours. Among 200 hours when the PICU was at full capacity, 75% of the time included at least 1 bed that was used for non–critical care services; 37% of the time at least 2 beds. The mean waiting time for a floor bed assignment was 9 hours (median, 5.5 hours) and accounted for 4.62% of all bed‐hours observed.CONCLUSIONS:The PICU delivered critical care services most of the time, but periods of non–critical care services represented a significant amount of time. In particular, periods with no bed available for new patients were associated with at least 1 or more PICU beds being used for non–critical care activities. The method should be reproducible in other settings to learn more about the structure and processes of care and patient flow and to make improvements. Journal of Hospital Medicine 2012; © 2011 Society of Hospital Medicine

Unscheduled Readmissions to the PICU

“…Critical care beds are a limited resource, and there is constant pressure to maximize their use (22). The challenge of accommodating all patients requiring critical care services and providing high quality care to those patients has been characterized as "ICU capacity strain" (23).…”

Analysis of Interventions Required in 12,021 Children With Acute Intoxications Admitted to PICUs*

“…Due to advances in patient monitoring technology, pediatric early warning sign scores (1–6) and development of rapid response teams (7–9), patient care and monitoring capabilities on the general floors has dramatically improved over the past few decades. Simultaneously, there is a growing shortage of PICU beds as critical care resource utilization is rising (10), especially during the fall and winter months when there is a greater burden of respiratory illness. Pediatric poisonings and intoxications (both intentional and unintentional) account for 4.6% of annual admissions to the PICU (11).…”

A Pragmatic Method for Identification of Long-Stay Patients in the PICU

“…Alternatively, if by using this tool, most LSPs were in fact retrospectively identified as patients who required the use of ECLS, a hospital could use this information to decide whether it should continue to provide ECLS or whether it might be a more efficient use of hospital resources to put patients on ECLS and transport them to another center. 27 There are several limitations to this study. First, we did not ask health care providers or families for their perspectives on the LSP definition.…”