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Direct observation of bed utilization in the pediatric intensive care unit

Authors

  • Evan S. Fieldston MD, MBA, MSHP,

    Corresponding author
    1. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
    2. Division of General Pediatrics, Philadelphia, Pennsylvania
    3. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
    • The Children's Hospital of Philadelphia, 34th & Civic Center Boulevard, Philadelphia, PA 19104
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    • Tel.: 267-426-2903

  • Joan Li,

    1. The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
    2. The College of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Christian Terwiesch PhD,

    1. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
    2. The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Mark A. Helfaer MD,

    1. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
    2. Division of Critical Care Medicine, Philadelphia, Pennsylvania
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  • Judy Verger PhD, RN, CRNP, CCRN,

    1. The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
    2. School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Susmita Pati MD, MPH,

    1. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Division of Primary Care Pediatrics, State University of New York at Stony Brook and Stony Brook Long Island Children's Hospital, Stony Brook, New York
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  • David Surrey BA,

    1. Thomas Jefferson University College of Medicine, Philadelphia, Pennsylvania
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  • Kiran Patel MD, MS,

    1. The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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  • Jessica L. Ebberson MD,

    1. Seattle Children's Hospital, Seattle, Washington
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  • Richard Lin MD,

    1. Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
    2. Division of Critical Care Medicine, Philadelphia, Pennsylvania
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  • Joshua P. Metlay MD, PhD

    1. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
    2. Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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  • 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.

Abstract

BACKGROUND:

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.

OBJECTIVE:

The objective of this study was to describe, using direct observation, PICU bed utilization.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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

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