Can Utilization Review Criteria Be Used to Determine Appropriate Pediatric Patient Placement for a Critical Care Bed Expansion?

Jamieson, Donna; Mikhailov, Theresa A.; Maletta, Kristyn; Kuhn, Evelyn M.; Giuliani, Lauren; Musolf, Jeanne; Fischer, Kay A.; Collins, Maureen

doi:10.1097/00115514-201109000-00005

Cited by 1 publication

(5 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 It was beyond the scope of our study to explore the many evolving clinical and system factors beyond an actual or anticipated need for critical care-specific interventions that are considered by clinicians and contribute to disposition decisions in real-time. 2,3,5,6,19 In our study, one-third of patients were admitted to the ward, including 16 patients who were reviewed by the MET either as a follow up to their consult or as a new activation. When examining the impact of patient disposition on resource utilization, it is important to consider that strategies implemented to conserve resources in one area may be associated with increased resource consumption in other areas.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Ultimately, the potential benefit of implementing an IMCU must be considered in the context of a hospital's existing PICU resources. 6,13,23 In centres where PICU resources are inadequate to meet patient and system-level demands, it may be beneficial to explore IMCU implementation. 6,23 In centres with adequate PICU resources, it may be more practical to tolerate lower PICU admission thresholds and admit high acuity patients who only require close monitoring and frequent non-critical care interventions.…”

Section: Discussionmentioning

confidence: 99%

“…6,13,23 In centres where PICU resources are inadequate to meet patient and system-level demands, it may be beneficial to explore IMCU implementation. 6,23 In centres with adequate PICU resources, it may be more practical to tolerate lower PICU admission thresholds and admit high acuity patients who only require close monitoring and frequent non-critical care interventions. 1 Not surprisingly, our study demonstrated variation in nursing workload between and within reason for admission, and estimated lower nursing workload for patients who do not require critical care-specific interventions, but future studies using a more detailed scoring system may be helpful in defining health care provider skill sets required to care for these children.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] PICU physicians must consider many clinical and system factors when determining patient disposition following a consult in the Emergency Department (ED). [1][2][3][4]6 Given the finite amount of hospital resources and the pivotal importance of patient safety, it is important to understand which patients are likely to deteriorate or require critical care interventions or specific therapies that can only be offered in the PICU, and which patients may be safely cared for outside of the PICU. 4,5,7 It is also necessary to examine the impact that PICU admission decisions have on both critical care and hospital-wide resources.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Resource Utilization in Children who Receive a Pediatric Intensive Care Unit Consult in the Emergency Department: A Retrospective Cohort Study

Boggs

Caen

Lobos

et al. 2022

J Intensive Care Med

View full text Add to dashboard Cite

Objectives To describe the characteristics, critical care resource requirements, and outcomes of children who were hospitalized after a Pediatric Intensive Care Unit (PICU) consult in the Emergency Department (ED). Methods In this single-centre retrospective cohort study, we conducted chart reviews for children (<18 years) hospitalized following a PICU consult in the ED to examine patient characteristics, timing of consult, ED length of stay, Medical Emergency Team (MET) utilization, PICU nursing workload, and critical care interventions for children who were and were not admitted to the PICU. Results During the one-year study period, 247 PICU consults were performed in the ED resulting in 161 (65.2%) direct admissions to PICU and 1 indirect PICU admission via the ward. Of 105 children with complex chronic conditions, 73 (69.5%) were admitted to PICU, including 32 (91.4%) of 35 children with chronic home ventilatory needs, only 2 (6.2%) of whom received a critical care intervention beyond respiratory support. Within 24 h of hospitalization, 112 (69.1%) of 162 PICU admissions received a critical care-specific intervention. Of 86 (34.8%) ward admissions, 16 (18.6%) were reviewed by the MET. Children admitted to the ward had a significantly longer post-consult ED length of stay than children admitted to PICU (median 428 min vs. 130 min; p <0.0001). Conclusions Over two-thirds of children admitted to PICU from the ED required early critical care interventions, with the remainder potentially benefitting from closer monitoring or a higher frequency of non-critical care interventions than can be reasonably provided on general inpatient wards. More research is needed to evaluate critical care and hospital resource utilization when children are triaged to the ward following a PICU consult in the ED.

show abstract