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PICU Strain and Its Association With Patient Outcomes.

Matthew S Baker1,2, Kristen R Miller1, Michele M Loi1,2

  • 1Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|March 11, 2026
PubMed
Summary
This summary is machine-generated.

High patient turnover in pediatric intensive care units (PICUs) is linked to increased unplanned readmissions. Monitoring PICU strain, particularly turnover, can help improve patient outcomes and guide staffing decisions.

Keywords:
critical care outcomeshealth resourcespatient readmissionpediatric intensive care unitspediatricssurge capacity

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Area of Science:

  • Pediatric critical care medicine
  • Healthcare operations research
  • Patient safety and quality improvement

Background:

  • Pediatric intensive care unit (PICU) strain, a measure of operational demand, is not well-defined.
  • Understanding factors contributing to PICU strain is crucial for optimizing patient care and outcomes.

Purpose of the Study:

  • To quantify PICU strain using daily metrics like patient census and turnover.
  • To investigate the association between PICU strain and unplanned readmissions within 48 hours.

Main Methods:

  • Retrospective cohort study involving 32 PICUs.
  • Analysis of patient data from September 2014 to March 2023.
  • Generalized linear mixed models used to assess the impact of high census and turnover days on readmission rates.

Main Results:

  • Increased patient turnover (95th percentile) was significantly associated with a higher likelihood of early, unplanned PICU readmission (OR, 1.23; 95% CI, 1.14-1.33).
  • High patient census (95th percentile) on transfer days did not show a significant association with early readmissions.

Conclusions:

  • PICU turnover is a key indicator of operational strain and a predictor of adverse patient outcomes.
  • Monitoring and managing PICU turnover are essential for informing clinical operations and staffing to enhance patient safety.