Variation in Patient Characteristics Across Pediatric Intermediate Care Units.

Abstract

Objectives: This study describes pediatric intermediate care unit (PIMCU) and patient-level characteristics and the association of different PIMCU models with key patient and hospitalization outcomes.

Design: Retrospective analysis of hospital admissions.

Setting: Registry data from six PIMCUs in the U.S. Pediatric Health Information Systems database.

Patients: All PIMCU hospitalizations from January 2022 to December 2023.

Interventions: None.

Measurements: Key demographic data, clinical characteristics, and outcomes were extracted.

Main results: There were 8397 PIMCU encounters included from six 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 d), lower readmission rates (11% vs. 20.8%), and lower ICU transfer rates (3.9% vs. 7.3%).

Conclusions: Although all PIMCUs had similarities in nurse staffing, unit structure, and a focus on respiratory illness, we observed two PIMCU models: high-complexity and mixed-complexity units. These two unit types had distinct patient populations, reflecting different admissions practices, with high-complexity units more likely to admit ICU patients and technology-dependent patients. Units with higher CCC patient burden had significantly higher ICU transfer rates, readmission rates, and longer length of stay, associations that we hypothesize are a product of unit complexity. Further investigation is needed to understand the impact of these two PIMCU models on clinical outcomes and appropriate ICU-bed utilization. In the meantime, PIMCU patient composition could be considered when selecting unit benchmarks.