title: Direct observation of bed utilization in the pediatric intensive care unit.
abstract: BACKGROUND
  The pediatric intensive care unit (PICU), with limited number of beds and resource-intensive services, is a key component of patient flow. Because the PICU is a crossroads for many patients, transfer or discharge delays can negatively impact a patient's clinical status and efficiency.
  
  
  OBJECTIVE
  The objective of this study was to describe, using direct observation, PICU bed utilization.
  
  
  METHODS
  We conducted a real-time, prospective observational study in a convenience sample of days in the PICU of an urban, tertiary-care children's hospital.
  
  
  RESULTS
  Among 824 observed hours, 19,887 bed-hours were recorded, with 82% being for critical care services and 18% for non-critical care services. Fourteen activities accounted for 95% of bed-hours. Among 200 hours when the PICU was at full capacity, 75% of the time included at least 1 bed that was used for non-critical care services; 37% of the time at least 2 beds. The mean waiting time for a floor bed assignment was 9 hours (median, 5.5 hours) and accounted for 4.62% of all bed-hours observed.
  
  
  CONCLUSIONS
  The PICU delivered critical care services most of the time, but periods of non-critical care services represented a significant amount of time. In particular, periods with no bed available for new patients were associated with at least 1 or more PICU beds being used for non-critical care activities. The method should be reproducible in other settings to learn more about the structure and processes of care and patient flow and to make improvements.
authors: Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA. fieldston@email.chop.edu
authors: Evan S
authors: ES
authors: Fieldston
authors: Joan
authors: J
authors: Li
authors: Christian
authors: C
authors: Terwiesch
authors: Mark A
authors: MA
authors: Helfaer
authors: Judy
authors: J
authors: Verger
authors: Susmita
authors: S
authors: Pati
authors: David
authors: D
authors: Surrey
authors: Kiran
authors: K
authors: Patel
authors: Jessica L
authors: JL
authors: Ebberson
authors: Richard
authors: R
authors: Lin
authors: Joshua P
authors: JP
authors: Metlay
mesh_terms: D001509:Bed Occupancy / Q000706:statistics & numerical data*; D001513:Beds / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011446:Prospective Studies; D013997:Time Factors