Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar;19(3):196-203.
doi: 10.1097/PCC.0000000000001425.

PICU Length of Stay: Factors Associated With Bed Utilization and Development of a Benchmarking Model

Murray M Pollack  1 , Richard Holubkov  2 , Ron Reeder  2 , J Michael Dean  2 , Kathleen L Meert  2 , Robert A Berg  3 , Christopher J L Newth  4 , John T Berger  5 , Rick E Harrison  6 , Joseph Carcillo  7 , Heidi Dalton  8 , David L Wessel  9 , Tammara L Jenkins  6 , Robert Tamburro  10 ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN)
Collaborators, Affiliations

PICU Length of Stay: Factors Associated With Bed Utilization and Development of a Benchmarking Model

Murray M Pollack et al. Pediatr Crit Care Med. 2018 Mar.

Abstract

Objectives: ICU length of stay is an important measure of resource use and economic performance. Our primary aims were to characterize the utilization of PICU beds and to develop a new model for PICU length of stay.

Design: Prospective cohort. The main outcomes were factors associated with PICU length of stay and the performance of a regression model for length of stay.

Setting: Eight PICUs.

Patients: Randomly selected patients (newborn to 18 yr) from eight PICUs were enrolled from December 4, 2011, to April 7, 2013. Data consisted of descriptive, diagnostic, physiologic, and therapeutic information.

Interventions: None.

Measurements and main results: The mean length of stay for was 5.0 days (SD, 11.1), with a median of 2.0 days. The 50.6% of patients with length of stay less than 2 days consumed only 11.1% of the days of care, whereas the 19.6% of patients with length of stay 4.9-19 days and the 4.6% with length of stay greater than or equal to 19 days consumed 35.7% and 37.6% of the days of care, respectively. Longer length of stay was observed in younger children, those with cardiorespiratory disease, postintervention cardiac patients, and those who were sicker assessed by Pediatric Risk of Mortality scores receiving more intensive therapies. Patients in the cardiac ICU stayed longer than those in the medical ICU. The length of stay model using descriptive, diagnostic, severity, and therapeutic factors performed well (patient-level R-squared of 0.42 and institution-level R-squared of 0.76). Standardized (observed divided by expected) length of stay ratios at the individual sites ranged from 0.87 to 1.09.

Conclusions: PICU bed utilization was dominated by a minority of patients. The 5% of patients staying the longest used almost 40% of the bed days. The multivariate length of stay model used descriptive, diagnostic, therapeutic, and severity factors and has potential applicability for internal and external benchmarking.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest Statement: The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1
Figure 1
PICU and Hospital Length of Stay Distributions. PICU lengths of stay are skewed to short stays compared to hospital stays.
Figure 2
Figure 2
Utilization of PICUs by Percent of Admissions and Percent of Total PICU Days. Four ranges are displayed for approximately the shortest 50%, next 25%, next 20% and longest 5% LOS admissions. The corresponding percentage of days of PICU care used by these groups are indicated by identical fill patterns. Half of the study population (50.6%) with the shortest PICU LOS (less than 2 days) consumed only 11.1% of the days of care. In contrast, the 19.6% of patients with LOS 4.9 to 19 days and the 4.6% with LOS of 19 days or longer consumed 35.7% and 37.6% of the days of care respectively.
Figure 3
Figure 3
Length of Stay and Mortality Risk Versus Severity of Illness (PRISM). The median pediatric intensive care unit (PICU) LOS (solid line) and PICU mortality (hashed line) are plotted relative to the Pediatric Risk of Mortality (PRISM) score. As the PRISM score increases, the median LOS increases in parallel with mortality risk until a PRISM score of 20–25 when median LOS decreases due to increasing deaths.
Figure 4
Figure 4
Mean Observed Versus Predicted Length of Stay. Data are displayed by deciles of predicted LOS.
Figure 5
Figure 5
Observed and Predicted Length of Stay at the Participating Centers. The standardized length of stay ratio is the observed divided by the expected length of stay.
See this image and copyright information in PMC

References

    1. Breslow MJ, Badawi O. Severity scoring in the critically ill: part 2: maximizing value from outcome prediction scoring systems. Chest. 2012 Feb;141(2):518–527. - PubMed
    1. Gemke RJ, Bonsel GJ. Comparative assessment of pediatric intensive care: a national multicenter study. Pediatric Intensive Care Assessment of Outcome (PICASSO) Study Group. Crit Care Med. 1995 Feb;23(2):238–245. - PubMed
    1. Barrett MLSM, Elixhauser A, Honigman LS, Pines JM. Utilization of Intensive Care Services, 2011. Statistical Brief #185. Agency for Healthcare Research and Quality; 2014. - PubMed
    1. Ahmed S, Manaf NH, Islam R. Effects of Lean Six Sigma application in healthcare services: a literature review. Reviews on environmental health. 2013;28(4):189–194. - PubMed
    1. Zander K. A 30-Year Retrospective: Degrees of Difficulty in Decreasing LOS. Professional case management. 2016 Sep-Oct;21(5):233–242. - PubMed

Publication types