Triage of Intermediate-Care Patients in Pediatric Hospitals

Area of Science:

• Pediatric hospital medicine
• Healthcare management
• Patient flow optimization

Background:

• Hospitalized children exhibit diverse acuity levels and risk of decompensation.
• Current triage practices for non-invasively monitored pediatric patients requiring intense care are not well-defined.
• Understanding triage patterns is crucial for optimizing resource allocation and patient care.

Purpose of the Study:

• To determine pediatric patient triage destinations in hospitals for those needing enhanced monitoring but not invasive technology.
• To investigate the impact of intermediate care units (IMCUs) on triage decisions.

Main Methods:

• A telephone survey was conducted across US pediatric hospitals meeting specific bed and ward criteria.
• Hypothetical patient scenarios (e.g., severe asthma, DKA, non-invasive ventilation) were presented to hospital bed coordinators or ED charge nurses.
• Respondents indicated the appropriate admission location: general floor, ICU, or IMCU.

Main Results:

• 164 out of 192 eligible hospitals responded (85% response rate).
• Most institutions triaged the majority of hypothetical patient scenarios to the Pediatric Intensive Care Unit (PICU).
• Hospitals with an IMCU were significantly less likely to triage these patients to the ICU (P < .001), with 17% triaging at least one scenario to an IMCU.

Conclusions:

• Pediatric inpatient triage practices for patients needing close nursing care or monitoring vary significantly.
• The availability of an IMCU demonstrably influences triage decisions, decreasing PICU utilization for specific patient populations.
• Implementing IMCUs may be an effective strategy for managing children with acute illnesses or respiratory technology needs without requiring PICU-level resources.