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.
Insights
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.
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.
Objectives:
To measure PICU strain and test for associations between strain and patient outcomes. We hypothesized that patients transferred from the PICU during high compared with low strain periods would be more likely to experience an unplanned PICU readmission within 48 hours.
Design:
Retrospective cohort study.
Setting:
Thirty-two PICUs in the Virtual Pediatric Systems, LLC database.
Study Population:
Patients transferred from the PICU between September 1, 2014, and March 31, 2023.
Interventions:
None.
Measurements And Main Results:
We characterized volume-based strain metrics daily including census defined as number of PICU patients and turnover defined as number of PICU admissions, transfers, or discharges. To account for fluctuations in bed availability and staffing, we identified the days with the highest (95th percentile) census and turnover for each quarter and each PICU. We used generalized linear mixed models to test for an association between being transferred from the PICU during days with the highest census and turnover (95th percentile) and experiencing an early, unplanned PICU readmission. After adjusting for patient-level confounders and correlation among PICUs, we identified that patients transferred on days when turnover was in the 95th percentile were more likely to experience an early, unplanned PICU readmission (odds ratio, 1.23; 95% CI, 1.14-1.33) compared with those transferred on days when turnover was less than 95% percentile. Being transferred on a day during which the census was in the 95th percentile was not associated with experiencing an early, unplanned readmission.
Conclusions:
This multicenter PICU study demonstrated that turnover is a valuable PICU strain metric that should be used to inform clinical operations and staffing decisions to optimize patient outcomes.
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