Variation in Patient Characteristics Across Pediatric Intermediate Care Units

This study describes pediatric intermediate care unit (PIMCU) and patient-level characteristics and the association of different PIMCU models with key patient and hospitalization outcomes.

Retrospective analysis of hospital admissions.

Registry data from six PIMCUs in the U.S. Pediatric Health Information Systems database.

All PIMCU hospitalizations from January 2022 to December 2023.

None.

Key demographic data, clinical characteristics, and outcomes were extracted.

There were 8397 PIMCU encounters included from six units. All included PIMCUs had similar nurse staffing models and commonly cared for patients with respiratory illness. They all cared for a large percentage of patients with complex chronic conditions (CCC), ranging from 31.4% to 94.8%. Compared to high-complexity units (>75% of patients with a CCC; n = 2), mixed-complexity units (25-75% of patients with a CCC; n = 4) were more likely to source patients from the ED (45.1% vs. 20.2%) and prioritize high-acuity/low-complexity diagnoses. Mixed-complexity units had shorter hospital length of stays (median 3 vs. 8 d), lower readmission rates (11% vs. 20.8%), and lower ICU transfer rates (3.9% vs. 7.3%).

Although all PIMCUs had similarities in nurse staffing, unit structure, and a focus on respiratory illness, we observed two PIMCU models: high-complexity and mixed-complexity units. These two unit types had distinct patient populations, reflecting different admissions practices, with high-complexity units more likely to admit ICU patients and technology-dependent patients. Units with higher CCC patient burden had significantly higher ICU transfer rates, readmission rates, and longer length of stay, associations that we hypothesize are a product of unit complexity. Further investigation is needed to understand the impact of these two PIMCU models on clinical outcomes and appropriate ICU-bed utilization. In the meantime, PIMCU patient composition could be considered when selecting unit benchmarks.