An objective method to evaluate rationing of pediatric intensive care beds

Rationing of pediatric intensive care beds occurs when the severity of illness of patients admitted to and discharged from the PICU is inversely proportional to the number of available PICU beds. Bed rationing may also increase the proportion of patients using unique PICU therapies, thereby increasing efficiency. Consecutive PICU admissions (n = 283) were evaluated for three months for descriptive data, daily severity of illness, and daily care modalities. PICU and hospital censuses were also recorded. The mean PICU occupancy was 75% (range 37.5%-100%), the hospital occupancy was 79% (range 60%-96%) and the daily PICU efficiency was 78% (range 50%-100%). The PICU census was greater than 90% on 13% of the study days. Neither PICU nor hospital census was associated with the severity of illness of patients admitted to or discharged from the PICU. Severity of illness for patients admitted when only one bed was available or discharged when there were no available beds was not higher than at other times. Therefore, we did not find evidence of rationing of pediatric intensive care by using quantitative methods. As health care funding becomes more limited, quantitative analyses such as this study differentiating the need for more PICU beds from the need for better PICU bed utilization will be beneficial.