Key result
Long-stay PICU patients consume ~33% of total admission days and drive disproportionate ECMO use.
Why the study?
The study was conducted to examine the characteristics of long-stay patients admitted to a PICU and investigate their discharge characteristics regarding medical complexity.
Cohort (n=3,375)
No
Long-stay PICU patients represent a small minority of admissions but consume a disproportionately large share of resources and have high medical complexity after discharge.
Identifies long-stay PICU patients as high-resource users; supports targeted interventions but requires prospective validation.
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.
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Boerman et al. (2023) conducted a cohort in PICU admission (n=3,375). Long PICU stay (≥28 consecutive days) vs. Shorter PICU stay was evaluated on Proportion of total PICU admission days consumed. Long-stay patients (≥28 days) represented only 3.2% of PICU admissions but consumed 33% of admission days, 47% of ECMO days, and 38% of mechanical ventilation days.
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