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

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. Dr. Dalton is currently affiliated with INOVA Fairfax Medical Center and George Washington University, Washington, DC. This content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health. Dr. Pollack participated in conceptualization, design, data acquisition, and data analysis. Drs. Holubkov, Reeder, and Dean participated in conceptualization, design, and data analysis. Drs. Meert, Berg, Newth, Berger, Harrison, Carcillo, Dalton, and Wessel participated in conceptualization, design, and data acquisition. Ms. Jenkins participated in conceptualization and design. Dr. Tamburro participated in data analysis. All authors participated in data interpretation and drafting/revision. All authors have given final approval and have agreed to be accountable for all aspects of the work. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/2gIrZ5Y). Supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services: U10HD050096, U10HD049981, U10HD049983, U10HD050012, U10HD063108, U10HD063106, U10HD063114 and U01HD049934. All authors received support for article research from the National Institutes of Health (NIH). Drs. Pollack, Dean, Meert, Newth, Berger, Harrison, and Wessel's institutions received funding from the NIH. Drs. Holubkov, Reeder, Berg, Carcillo, and Dalton's institutions received funding from the National Institute of Child Health and Human Development. Dr. Holubkov received funding from DSMB memberships for Pfizer, Medimmune, and Armaron, and he disclosed that he was a biostatistical consultant for St Jude Medical (past), is on the Physicians Committee for Responsible Medicine (current), and was a Data Safety and Monitoring Board Member for American Burn Association (past). Dr. Newth received funding from Philips Research North America. Dr. Dalton received funding from Innovate ECMO Concepts Inc.(consultant) and Maquet Speakers Bureau. Drs. Jenkins and Tamburro disclosed government work. Dr. Jenkins disclosed that she completed this article as a federal employee at the NIH. Dr. Tamburro's institution received funding from Ony, Inc. and the U.S. Food and Drug Administration Office of Orphan Product Development, and he received funding from Springer Publishing. For information regarding this article, E-mail: mpollack@childrensnational.org ©2017The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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