The Challenges of Caring for Long-Stay Patients in the PICU*

Abstract

Objective: Compared to shorter-stay patients, caring for long-stay patients in the ICU entails a disproportionate burden for staff. Our objective was to gain a deeper understanding of the impact on staff of caring for children who have a prolonged stay on the PICU. Design: Qualitative study based on semi-structured interviews. Data were analyzed using the Framework approach. Setting: Children’s tertiary hospital. Participants: Seventeen members of staff (7 psychosocial staff, 7 nurses, 3 consultants) working in the PICU, neonatal ICU, or cardiac ICU (PICU will be used to encompass neonatal ICU, cardiac ICU, and PICU for the remainder of this article). Interventions: Semi-structured, tape-recorded interviews. Measurements and Main Results: Staff reported both positive and challenging aspects of caring for long-stay patients in the PICU. Five key areas relating to the challenges of caring for long-stay patients were identified: staff expectations about their work, characteristics of the patient group, the impact on staff, the impact on the wider unit, and the availability of support. Staff views were often compounded by individual cases they had been involved with or had heard about which fell at either end of the spectrum of “good” and “bad”. Conclusions: Whilst there are reported benefits associated with caring for long-stay patients, there are a number of challenges reported that may have implications for staff and the wider unit. When caring for a particular sub-group of long-stay patients, staff may be more likely to experience negative impacts. A key priority for the PICU is to ensure that support mechanisms are timely, accessible, and allow staff to explore their own reactions to their work.

Length of stay in pediatric intensive care unit: prediction model

“…Finally, the value would be greater than -0.855, the LOS would be from 3 to 4 days. RS>4= 1.2 -0.01xA + 0.0001xA 2 -0.71xB -1.08xC -0.35xD -0.34xE -0.03xF -1.46xG + 0.03xH -1.57xI + 0.68xJ + 0.29xL -0.01xL 2…”

“…Potential results would also allow care planning, aiming, whenever possible, hospital discharge. (1,2) Prediction models of risk are used to prevent risk of specific event -in this case, the chance of hospitalization einstein (São Paulo). 2020;18:1-6 from 1 to 2 days, 3 to 4 days, and greater than 4 days.…”

“…Therefore, not considering the assessment of prevalence and the type of chronic condition can lead to a barrier to predicting LOS for these children. (1,2) However, to consider to include post-admission variables that would be possible to increase the chance of accurate prediction model would end up decrease the impact of advantages of immediate estimation of LOS upon admission.…”

“…For this reason, PICU requires a large amount of hospital resources and the efficient management of intensive care therapy bed is crucial, given that this is a limited resource. (1)(2)(3) We define length of stay (LOS) as the period between date and time of intensive care unit (ICU) admission, and date and time of ICU discharge. (4) The efficiency and quality of critical care are associated with LOS, and its control is important to promote safety and patient satisfaction, in addition to maintain financial viability of hospitals.…”

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

“…Because of the small sample size, responses were not stratified by center. Open-ended questions were analyzed by using the framework method, 14,15 which is used to assess both the central research question and the specific nature of the responses and has been previously used to analyze qualitative data on LSPs in the PICU. 6…”