Characteristics of Long-Stay Patients in a PICU and Healthcare Resource Utilization After Discharge

Critical Care Explorations · 4 authors, 3 centres

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TL;DR

This retrospective cohort study found that children staying 28 days or longer in a PICU represent a small proportion of patients but consume a large share of resources.

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This retrospective cohort study examined children admitted for 28 days or longer to a single Dutch PICU between 2017 and 2020. The study found that LSPs constituted 3.2% of admissions but consumed 33% of total admission days, 47% of ECMO days, and 38% of mechanical ventilation days. After hospital discharge, 76% of LSPs were classified as children with medical complexity. All received discharge medications (median 5.5), 89% had a chronic disease, 82% left with technological devices, and 93% required involvement of allied healthcare professionals. The study notes limitations including its single-center design, lack of long-term follow-up data, and uncertainty about changes in outpatient care after discharge. The findings suggest a high burden of complex care needs extending beyond PICU discharge.

STUDY TYPE

cohort

SPECIALTY

pediatrics

SUMMARISED BY

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ORIGINAL PAPER

PMC10461958

Characteristics of Long-Stay Patients in a PICU and Healthcare Resource Utilization After Discharge

Critical Care Explorations

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ABSTRACT

Abstract OBJECTIVES: To examine the characteristics of long-stay patients (LSPs) admitted to a PICU and to investigate discharge characteristics of medical complexity among discharged LSP. DESIGN: We performed a retrospective cohort study where clinical data were collected on all children admitted to our PICU between July 1, 2017, and January 1, 2020. SETTING: A single-center study based at Erasmus MC Sophia Children’s Hospital, a level III interdisciplinary PICU in The Netherlands, providing all pediatric and surgical subspecialties. PATIENTS: LSP was defined as those admitted for at least 28 consecutive days. INTERVENTIONS: None. MEASUREMENTS: Length of PICU stay, diagnosis at admission, length of mechanical ventilation, need for extracorporeal membrane oxygenation, mortality, discharge location after PICU and hospital admission, medical technical support, medication use, and involvement of allied healthcare professionals after hospital discharge. MAIN RESULTS: LSP represented a small proportion of total PICU patients (108 patients; 3.2%) but consumed 33% of the total admission days, 47% of all days on extracorporeal membrane oxygenation, and 38% of all days on mechanical ventilation. After discharge, most LSP could be classified as children with medical complexity (CMC) (76%); all patients received discharge medications (median 5.5; range 2–19), most patients suffered from a chronic disease (89%), leaving the hospital with one or more technological devices (82%) and required allied healthcare professional involvement after discharge (93%). CONCLUSIONS: LSP consumes a considerable amount of resources in the PICU and its impact extends beyond the point of PICU discharge since the majority are CMC. This indicates complex care needs at home, high family needs, and a high burden on the healthcare system across hospital borders. Keywords: children with medical complexity, discharge, long-stay patients, pediatric intensive care unit, transitional care units

CITATION EXPORT

Gerharda H Boerman, Heleen N Haspels, Matthijs de Hoog et al.. Characteristics of Long-Stay Patients in a PICU and Healthcare Resource Utilization After Discharge. Critical Care Explorations. (2023). https://doi.org/10.1097/CCE.0000000000000971

AUTHORS

4 · 3 CENTRES

Gerharda H Boerman, Heleen N Haspels, Matthijs de Hoog, Koen F Joosten

1 Division of Pediatric Intensive Care, Department of Neonatology and Pediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands.
2 Department of Pediatric Intensive Care Unit, Amsterdam Reproduction, and Development, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
3 Transitional Care Unit Consortium, The Netherlands.