Effects of the presence of a pediatric intensivist on treatment in the pediatric intensive care unit

Abstract

Background: There are few studies on the effect of intensivist staffing in pediatric intensive care units (PICUs) in Korea. We aimed to evaluate the effect of pediatric intensivist staffing on treatment outcomes in a Korean hospital PICU.

Methods: We analyzed two time periods according to pediatric intensivist staffing: period 1, between November 2015 to January 2017 (no intensivist staffing, n=97) and period 2, between February 2017 to February 2018 (intensivists staffing, n=135).

Results: Median age at admission was 5.4 years (range, 0.7-10.3 years) in period 1 and 3.6 years (0.2-5.1 years) in period 2 (P=0.013). The bed occupancy rate decreased in period 2 (75%; 73%-88%) compared to period 1 (89%; 81%-94%; P=0.015). However, the monthly bed turnover rate increased in period 2 (2.2%; 1.9%-2.7%) compared to period 1 (1.5%, 1.1%- 1.7%; P=0.005). In both periods, patients with chronic neurologic illness were the most common. Patients with cardiovascular problems were more prevalent in period 2 than period 1 (P=0.008). Daytime admission occurred more frequently in period 2 than period 1 (63% vs. 39%, P<0.001). The length of PICU stay, parameters related with mechanical ventilation and tracheostomy, and pediatric Sequential Organ Failure Assessment score were not different between periods. Sudden cardiopulmonary resuscitations occurred in two cases during period 1, but no case occurred during period 2.

Conclusions: Pediatric intensivist staffing in the PICU may affect efficient ICU operations.

Keywords: cardiopulmonary resuscitation; child; critical care; intensive care units.

Figure 1.

Percentage of admitted patients as per priority. Period 1: between November 2015 to January 2017 (no intensivist staffing); period 2: between February 2017 to February 2018 (intensivists staffing); Priority 1, patients who required life support for organ failure, intensive monitoring, and therapies that are only available in the intensive care unit (ICU) environment; priority 2, patients who required active monitoring and immediate treatment at any time with no limits on the extent of the therapy; priority 3, patients who could be managed at a lower level of care than the ICU; priority 4, patients with low or no probability of recovery/survival.

Figure 2.

Cause for admission to pediatric intensive care unit (PICU). The three major causes for PICU admission during the two periods were cardiovascular, neurologic, and pulmonary problems. Period 1: between November 2015 to January 2017 (no intensivist staffing); period 2: between February 2017 to February 2018 (intensivists staffing).

Figure 3.

Classification of chronic illness. In both periods, patients with chronic neurologic illness were the most common. Period 1: between November 2015 to January 2017 (no intensivist staffing); period 2: between February 2017 to February 2018 (intensivists staffing).