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A Comparative Analysis of Eight Pediatric Intensive Care Units

Murray M. Pollack, MD; Pamela R. Getson, PhD; Urs E. Ruttimann, PhD; Curt M. Steinhart, MD; Robert K. Kanter, MD; Robert W. Katz, MD; Aaron R. Zucker, MD; Nancy L. Glass, MD; William A. Spohn, MD; Bradley P. Fuhrman, MD; James D. Wilkinson, MD

JAMA. 1987;258(11):1481-1486.

Abstract
To calculate overall pediatric intensive care unit (PICU) efficiency rates, 1668 patients representing 6962 patient-days were studied in eight PICUs. The contributions to inefficiency by two patient groups—low-risk monitored patients and potential early-discharge patients—were quantified using measures of daily mortality risk and therapeutic assessments. Low-risk monitored patients never received a unique PICU therapy and had daily mortality risks less than 1%. Potential early-discharge patients were similar to the low-risk monitored patients except that their unnecessary PICU use came only on their last consecutive day(s) of PICU stay. Efficiency ratings ranged from 0.894 to 0.547 in the eight PICUs. Low-risk monitored patients constituted from 16% to 58% of the PICU patient populations and used from 5.4% to 34.5% of the total days of care. Potential early-discharge patients constituted from 12% to 29% of the populations and the potential early-discharge days of care ranged from 5.1% to 17.2% of the total days of care. These results indicate that large disparity exists in efficiency among PICUs. Efficiency rates of greater than 0.80 seem to be a reasonable goal.

(JAMA 1987;258:1481-1486)

Author Affiliations
From the George Washington University School of Medicine and Health Sciences (Drs Pollack, Getson, and Wilkinson) and the Children's Hospital National Medical Center (Drs Pollack, Getson, and Wilkinson), Washington, DC; Diagnostic System Branch, National Institute of Dental Research, National Institutes of Health, Bethesda, Md (Dr Ruttimann); Medical College of Georgia, Augusta (Dr Steinhart); State University of New York, Health Sciences Center at Syracuse, Syracuse (Dr Kanter); University of New Mexico School of Medicine, Albuquerque (Dr Katz); The University of Chicago (Dr Zucker); The University of Texas Health Science Center at Houston, Houston (Dr Glass); Wright State School of Medicine, Dayton, Ohio (Dr Spohn); and the Department of Anesthesiology and Critical Care, University of Pittsburgh (Dr Fuhrman).

Footnotes
Reprint requests to Children's Hospital National Medical Center, 111 Michigan Ave NW, Washington, DC 20010 (Dr Pollack).

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