Long-stay patients in pediatric intensive care units

Abstract

Objectives: To explore the changing patterns of long-stay patients (LSP) to improve the utilization of pediatric intensive care units (PICUs) resources. Methods: This is a 2-points cross-sectional study (5 years apart; 2014-2019) conducted among PICUs and SCICUs in Riyadh, Saudi Arabia. Children who have stayed in PICU for more than 21 days were included. Results: Out of the 11 units approached, 10 (90%) agreed to participate. The prevalence of LSP in all these hospitals decreased from 32% (48/150) in 2014 to 23.4% (35/149) in 2019. The length of stay ranged from 22 days to 13.5 years. The majority of LSP had a neuromuscular or cardiac disease and were admitted with respiratory compromise. Ventilator-associated pneumonia was the most prevalent complication (37.5%). The most commonly used resources were mechanical ventilation (93.8%), antibiotics (60.4%), and blood-products transfusions (35.4%). The most common reason for the extended stay was medical reasons (51.1%), followed by a lack of family resources (26.5%) or lack of referral to long-term care facilities (22.4%). Conclusion: A long-stay is associated with significant critical care bed occupancy, complications, and utilization of resources that could be otherwise utilized as surge capacity for critical care services. Decreasing occupancy in this multicenter study deserves further engagement of the healthcare leaders and families to maximize the utilization of resources.

Predictors and Direct Cost Estimation of Long Stays in Pediatric Intensive Care Units in Saudi Arabia: A Mixed Methods Study

“…As reported in our previous publication, between 2014 and 2019, the LSP’s overall percentage in all surveyed hospitals dropped by 7.5%, from 31% to 23.5%. 9 At the hospital level, each unit varied in its improvement, from between a 5% to a 33% drop in their LSP percentage (see Figure 2 ). One outlier unit had entirely resolved its LSP issue (0 cases in 2019, from two cases and a percentage of 28.6% in 2014).…”

“…This paper is a continuum to previous research by the authors, 9 which explains data source, data collection tool, recruitment, and data collection process. The same seven PICUs and three pediatric SCICUs in Riyadh, Saudi Arabia, were included in the current study.…”

“…8 Locally, the issue of LSP was showing a trend of decrease, with the prevalence of LSP in several hospitals in Saudi Arabia decreasing from 32% in 2014 to 23.4% in 2019. 9 Nevertheless, the impact of LSP in PICUs and factors related to this still need to be addressed.…”

“…This study aimed to explain our previous quantitative findings on the change in LSP prevalence and characteristics 9 in Saudi Arabia and provide practical and relevant recommendations to decision-makers. For that, we obtained insights from multiple PICU and pediatric surgical cardiac intensive care unit (SCICU) leaders about the perceived factors that improved or worsened LSP outcomes in their settings over the past five years.…”

Enhancing Expert Panel Discussions in Pediatric Palliative Care: Innovative Scenario Development and Summarization With ChatGPT-4

“…Following the panel and conference attendees' discussions, the use of ChatGPT-4 helped to summarize the extensive human-human discussions, rapidly and reliably, with the AI generating a structured summarization in these complex medical situations that contribute to prolonged hospitalization and resource utilization [19][20][21]. We hereby demonstrated for the first time in the medical literature integrating ChatGPT-4 in re-generating more interactive and challenging scenarios [22][23][24], then using the same AI chatbot to analyze and summarize the panel discussion transcripts to provide a meaningful summary of key themes, insights, and expert consensus recommendations, to be shared with the medical literature.…”