Strain in the Pediatric Intensive Care Unit and its Association with Patient Outcomes

Area of Science:

• Pediatric Critical Care Medicine
• Healthcare Operations Research
• Patient Safety

Background:

• Pediatric intensive care units (PICUs) experience periods of high demand, referred to as strain.
• Understanding the impact of PICU strain on patient outcomes is crucial for optimizing care delivery and patient safety.

Purpose of the Study:

• To characterize measures of pediatric intensive care unit (PICU) strain.
• To investigate the association between PICU strain metrics and patient outcomes, specifically post-ICU floor escalation events.

Main Methods:

• Retrospective cohort study of PICU admissions from 2014-2023.
• Daily measurement of PICU strain metrics: percent occupancy, percent turnover, and acuity.
• Multivariable logistic regression analysis to assess the association between strain metrics and floor escalation events.

Main Results:

• PICU occupancy and turnover were significantly higher during peak viral seasons.
• Higher percent occupancy (above 87.5%) and turnover were independently associated with an increased risk of floor escalation events.
• Acuity metrics did not significantly differ between peak and non-peak seasons.

Conclusions:

• Percent occupancy and turnover are key indicators of PICU strain.
• Elevated PICU occupancy and turnover are linked to an increased incidence of post-ICU floor escalation events.
• Further multicenter studies are warranted to validate these findings across diverse PICU settings.