title: Growth, development, and failure to thrive: factors that underlie the availability of pediatric critical care facilities in the United States.
abstract: OBJECTIVE
  Pediatric intensive care units (PICUs) have grown in number and size over time in aggregate across the United States, but the factors promoting such changes have not been well characterized. This study was conducted to explore the establishment, expansion, and closure of PICUs.
  
  
  METHODS
  A cross-sectional in-depth telephone interview survey of executive hospital administrators.
  
  
  METHODS
  Fourteen institutions representing four newly established PICUs, two PICU expansions, and eight PICU closures.
  
  
  RESULTS
  Officials' comments indicate that the establishment of PICUs is driven primarily by the need to care for patients requiring intensive cardiorespiratory monitoring and/or postoperative surgical care and to respond to the needs of outlying community hospitals. The main factors that drive PICU expansion are institutional growth in pediatric subspecialist medical and surgical support for critically ill patients and the need to match increases in demand and patient volume experienced by existing PICUs. With regard to PICU closures, competition from other institutions within the same market for patients and subspecialty care providers, lower-than-expected volumes of patients, and/or negative financial margins were cited as key factors.
  
  
  CONCLUSIONS
  This study provides new insight into decision-making that influences the availability of critical care services for children. The establishment, expansion, and closure of PICUs are driven predominantly by local demand for pediatric critical care services, whereas availability of subspecialists as well as competition between PICUs within the same market affect the long-term sustainability of such services.
authors.affiliation: Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Folafoluwa O
authors.initials: FO
authors.lastname: Odetola
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D003659:Decision Making, Organizational; D004465:Economic Competition; D019538:Health Care Surveys; D006271:Health Facility Closure; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration / Q000600:supply & distribution*; D014481:United States