PICU Strain and Its Association With Patient Outcomes

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.

Retrospective cohort study.

Thirty-two PICUs in the Virtual Pediatric Systems, LLC database.

Patients transferred from the PICU between September 1, 2014, and March 31, 2023.

None.

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.

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.