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Characteristics of Long-Stay Patients in a PICU and Healthcare Resource Utilization After Discharge
Gerharda H Boerman1, Heleen N Haspels1,2,3, Matthijs de Hoog1,3
1Division of Pediatric Intensive Care, Department of Neonatology and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Long-stay patients (LSPs) in pediatric intensive care units (PICUs) consume significant resources. Most LSPs are children with medical complexity (CMC), requiring extensive support post-discharge.
Area of Science:
- Pediatric Intensive Care
- Healthcare Resource Utilization
- Complex Care Management
Background:
- Long-stay patients (LSPs) represent a significant challenge in pediatric intensive care units (PICUs).
- Understanding their resource consumption and post-discharge needs is crucial for effective healthcare planning.
Purpose of the Study:
- To characterize long-stay patients (LSPs) admitted to a pediatric intensive care unit (PICU).
- To investigate the medical complexity and discharge characteristics of these LSPs.
Main Methods:
- Retrospective cohort study of children admitted to a level III interdisciplinary PICU.
- Data collected on admissions between July 1, 2017, and January 1, 2020.
- Long-stay patients (LSPs) defined as those admitted for ≥28 consecutive days.
Main Results:
- LSPs (3.2% of patients) consumed 33% of PICU days, 47% of extracorporeal membrane oxygenation (ECMO) days, and 38% of mechanical ventilation days.
- Post-discharge, 76% of LSPs were classified as children with medical complexity (CMC).
- Most LSPs required multiple medications (median 5.5), had chronic diseases (89%), used technological devices (82%), and needed allied healthcare (93%).
Conclusions:
- LSPs place a substantial burden on PICU resources, extending beyond their intensive care stay.
- The majority of LSPs are CMC, highlighting significant ongoing care needs at home.
- This necessitates comprehensive support systems for families and the broader healthcare system.
Objectives:
To examine the characteristics of long-stay patients (LSPs) admitted to a PICU and to investigate discharge characteristics of medical complexity among discharged LSP.
Design:
We performed a retrospective cohort study where clinical data were collected on all children admitted to our PICU between July 1, 2017, and January 1, 2020.
Setting:
A single-center study based at Erasmus MC Sophia Children's Hospital, a level III interdisciplinary PICU in The Netherlands, providing all pediatric and surgical subspecialties.
Patients:
LSP was defined as those admitted for at least 28 consecutive days.
Interventions:
None.
Measurements:
Length of PICU stay, diagnosis at admission, length of mechanical ventilation, need for extracorporeal membrane oxygenation, mortality, discharge location after PICU and hospital admission, medical technical support, medication use, and involvement of allied healthcare professionals after hospital discharge.
Main Results:
LSP represented a small proportion of total PICU patients (108 patients; 3.2%) but consumed 33% of the total admission days, 47% of all days on extracorporeal membrane oxygenation, and 38% of all days on mechanical ventilation. After discharge, most LSP could be classified as children with medical complexity (CMC) (76%); all patients received discharge medications (median 5.5; range 2-19), most patients suffered from a chronic disease (89%), leaving the hospital with one or more technological devices (82%) and required allied healthcare professional involvement after discharge (93%).
Conclusions:
LSP consumes a considerable amount of resources in the PICU and its impact extends beyond the point of PICU discharge since the majority are CMC. This indicates complex care needs at home, high family needs, and a high burden on the healthcare system across hospital borders.
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