PolicyLab Researchers Describe How Understanding PICU Bed Use Can Inform Measures to Improve Patient Outcomes


PolicyLab researcher Evan Fieldston, MD, MBA, MSHP, worked with a multidisciplinary team of researchers including nurses, physicians, quality improvement specialists, and operations management to conduct a real-time observation of how beds in the PICU of an urban, tertiary-care children’s hospital were used over a total of 824 hours (representing 19,887 patient bed hours, total).

The researchers found that while the majority of bed use in the PICU was devoted to delivering critical care services (82%), 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, such as an excessively long amount of time for room preparation.

Because the PICU is a crossroads for so many hospital patients, it represents a critical component of managing patient flow, and is linked to the quality, safety, and cost of patient care. Transfer or discharge delays can negatively impact patient outcomes and opportunity losses (eg, postponed surgery, diverted transports, or inability to accept patients).

“This study provides a method for hospitals to conduct an operational analysis and determine points of focus to improve patient flow- not just in the ICU but in other hospital settings. Our findings strongly suggest that a good place to start is to target the non-clinical processes, such as bed assignment or time to clean rooms,” explained Dr. Fieldston. “This methodology is valuable because it identifies bottlenecks that would have been difficult to identify by reviewing administrative records.”

To read the full study in the Journal of Hospital Medicine, visit http://onlinelibrary.wiley.com/doi/10.1002/jhm.993/abstract.

About PolicyLab
PolicyLab at The Children’s Hospital of Philadelphia develops evidence-based solutions for the most challenging health-related issues affecting children. PolicyLab engages in research that is both responsive to community needs and relevant to policy priorities, partnering with practitioners, policymakers, and families throughout the research process. Through its work, PolicyLab identifies the programs, practices, and policies that support the best outcomes for children and their families, disseminating its findings beyond research and academic communities as part of its commitment to transform evidence to action. For more information about PolicyLab, visit http://www.policylab.us/