Length of stay and efficiency in pediatric intensive care units

Objective: Assessment of pediatric intensive care unit (PICU) efficiency with a length of stay prediction model and validation of this assessment by an efficiency measure based on daily use of intensive care unit-specific therapies. Design: Inception cohort study of data acquired between 1989 and 1994. Setting: Thirty-two PICUs, 16 selected randomly and 16 volunteering. Subjects: Consecutive admissions of 10,658 patients (466 deaths) who stayed at least 2 hours and up to 12 days in the PICU. Measurements: Length of stay and its prediction from a model with admission day data (PRISM III-24, diagnostic factors, mechanical ventilation). For validation, 11 PICUs recorded each patient's "efficient" days, that is, days when at least one PICU-specific therapy was given. PICU efficiency was computed as either the ratio of the observed efficient days or the days accounted for by the predictor variables to the total care days, and the agreement was assessed by Spearman's rank correlation analysis. Results: The total care days provided by each PICU (n = 32) were well predicted by the length of stay model (r = 0.946). The agreement in 11 validation PICUs between therapy-based efficiency (range 0.30 to 0.67) and predictor-based efficiency (range 0.31 to 0.63) was excellent (rank correlation r = 0.936, p < 0.0001). Conclusion: PICU efficiency comparisons with either method are nearly equivalent. Predictor-based efficiency has the advantage that it can be computed from admission day data only.