Characteristics of long-stay patients and their effect on institutional efficiency

Introduction: Length of stay (LOS) in the pédiatrie intensive care unit (PICU) is a reflection of seventy of illness, health status, and PICU qualm- and performance Long stay1 patients (LSPs) have less favorable outcomes and consume more health care resources. Reduction in LOS for LSPs could save substantial resources They also may effect measures of PICU quality and efficiency. We determined the relative resource use and clinical profiles of LSPs for potential quality and cost savings interventions. Methods: Data were obtained from 11,165 consecutive admissions to 32 PICUs (1) LSPs were defined as patients having a LOS >95th percentile (>12 days). LSP characteristics were compared to those of non-LSPs. PICU efficient days were defined as days requiring myhamTal ventilation or vasoactive infusions. Results: LSPs were 4.7% of the population, but used 36.1% of the days of care. The mean LOS of LSPs was 28 0 days compared to 2.4 days for short stay patients. LSPs were younger (age = 44.4 months vs 64.7, p<0.001), had more chronic care devices (gastrostonry tube, home tracheostomy, home ventilation, p<0.001 for all), were sicker on presentation (PRISM HI-24 = 9.6 vs 3.9, p<0.001), were more likely to have invasive procedures while in the PICU (intubations, central lines, arterial lines, intracranial monitoring. p0.001 for all), and were more likely to die (mortality = 15.2% vs 4.4%, p<0.001). The overall efficiency of LSPs was greater (79.2%) than non-LSPs (44.9%). Conclusions: The clinical profile of LSPs can be identified and could help prospectively identify future LSPs. The proportion of LSPs may also effect an individual PICU's measured efficiency If identified carry in the PICU course, measures such as critical pathways could be taken to improve care and lower PICU costs.