362 - Variation in Patient Characteristics Across Pediatric Intermediate Care Units

Publication Number: 4355.362

Alla Smith, Boston Children's Hospital, Brookline, MA, United States; Michael Agus, Harvard Medical School, Boston, MA, United States; Ekua Cobbina, Loma Linda University Children's Hospital, Loma Linda, CA, United States; Nicholas Ettinger, Children's Healthcare of Atlanta/Emory University School of Medicine, Atlanta, GA, United States; MIrna Giordano, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Taylor Jackvony, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Michael Northrop, Wake Forest Baptist Health - Brenner Children's Hospital, Winston Salem, NC, United States; Amee Patel, University of Texas Southwestern Medical School, Dallas, TX, United States; Paul Scalici, University of Alabama School of Medicine, Birmingham, AL, United States; Nathan A. Serazin, Baylor College of Medicine, Houston, TX, United States; Matt hall, Children's Hospital Association, Lenexa, KS, United States

Background: Published data are scarce about patients cared for in pediatric intermediate care units (PIMCUs).

Objective: This study describes PIMCU unit and patient-level characteristics and the impact of different PIMCU models on key patient and hospitalization outcomes.

Design/Methods: This is a retrospective analysis of all PIMCU hospitalizations from January 2022 to December 2023 at 6 hospitals nationwide. PIMCU patients were identified in the Pediatric Health Information System (PHIS) database and key outcomes and attributes were extracted from PHIS.

Results: There were 8,397 PIMCU encounters included from 6 units. All included PIMCUs had similar nurse staffing models and commonly cared for patients with respiratory illness. They all cared for a large percentage of patients with complex chronic conditions (CCC), ranging from 31.4% to 94.8%. Compared to high-complexity units (>75% of patients with a CCC, N=2), mixed complexity units (25-75% of patients with a CCC, N=4) were more likely to source patients from the ED (45.1% vs. 20.2%) and prioritize high-acuity/low-complexity diagnoses. Mixed-complexity units had shorter hospital length of stays (Median 3 vs. 8 days), lower readmission rates (11% vs. 20.8%) and lower intensive care unit (ICU) transfer rates (3.9% vs. 7.3%).

Conclusion(s): Despite similarities in nurse staffing, structure, and focus on respiratory illness, we describe two models of PIMCUs: high-complexity/"step-down" and mixed-complexity/"step-up" units. These two unit types had distinct triage practices, and significant differences in ICU transfer rate, readmission rate, and length of stay. Desired PIMCU patient composition should be considered when designing triage practices or selecting appropriate benchmarks.

Relationship between the percent of PIMCU patients with CCC and key outcomes
A) The percentage of PIMCU patients requiring ICU Transfer as a function of the percentage of patients with a CCC
B) Average Hospital Length of stay as a function of the percentage of PIMCU patients with a CCC
C) The percentage of PIMCU patients requiring 30-day Readmission as a function of the percentage of patients with a CCC

Hospital characteristics during the data collection period
Table 1.pdf

PIMCU Patient Characteristics
PIMCU Patient Characteristics
A) By Hospital
B) By PIMCU Unit Type