Version of Record online: 21 NOV 2011
Copyright © 2011 Society of Hospital Medicine
Journal of Hospital Medicine
Volume 7, Issue 4, pages 318–324, April 2012
How to Cite
Fieldston, E. S., Li, J., Terwiesch, C., Helfaer, M. A., Verger, J., Pati, S., Surrey, D., Patel, K., Ebberson, J. L., Lin, R. and Metlay, J. P. (2012), Direct observation of bed utilization in the pediatric intensive care unit. J. Hosp. Med., 7: 318–324. doi: 10.1002/jhm.993
This article was presented in abstract form at the Robert Wood Johnson Foundation Clinical Scholars National Meeting in November 2009.
Disclosure: The authors have no conflicts of interest to report.
- Issue online: 4 APR 2012
- Version of Record online: 21 NOV 2011
- Manuscript Accepted: 2 OCT 2011
- Manuscript Revised: 19 AUG 2011
- Manuscript Received: 28 APR 2011
- Leonard Davis Institute of Health Economics at the University of Pennsylvania
- Robert Wood Johnson Foundation Clinical Scholars program
The pediatric intensive care unit (PICU), with limited number of beds and resource-intensive services, is a key component of patient flow. Because the PICU is a crossroads for many patients, transfer or discharge delays can negatively impact a patient's clinical status and efficiency.
The objective of this study was to describe, using direct observation, PICU bed utilization.
We conducted a real-time, prospective observational study in a convenience sample of days in the PICU of an urban, tertiary-care children's hospital.
Among 824 observed hours, 19,887 bed-hours were recorded, with 82% being for critical care services and 18% for non–critical care services. Fourteen activities accounted for 95% of bed-hours. Among 200 hours when the PICU was at full capacity, 75% of the time included at least 1 bed that was used for non–critical care services; 37% of the time at least 2 beds. The mean waiting time for a floor bed assignment was 9 hours (median, 5.5 hours) and accounted for 4.62% of all bed-hours observed.
The PICU delivered critical care services most of the time, but periods of non–critical care services represented a significant amount of time. In particular, periods with no bed available for new patients were associated with at least 1 or more PICU beds being used for non–critical care activities. The method should be reproducible in other settings to learn more about the structure and processes of care and patient flow and to make improvements. Journal of Hospital Medicine 2012; © 2011 Society of Hospital Medicine