Effect of a monitored care unit on resource utilization in a pediatric ICU

OBJECTIVE: To determine the effect of a monitored care unit on resource utilization in a pediatric ICU. METHODS: The study was done at a 205-bed pediatric medical center located in northern California. Efficiency of resource utilization in the pediatric ICU was evaluated by comparing the following factors before and after the implementation of a monitored care unit: (1) efficiency in the pediatric ICU, (2) number of patients turned away for lack of beds, (3) hours of nursing care per patient day, and (4) cost (as estimated from charge ratios) in the monitored care unit for care of patients admitted because of some common reasons. RESULTS: Efficiency in the pediatric ICU increased significantly after implementation of a monitored care unit. The number of patients not admitted to the pediatric ICU because not enough beds were available was identical before and after establishment of the monitored care unit. After the monitored care unit was established, hours of nursing care per patient day were significantly reduced, enabling the number of patient days to be increased without increasing cost. In addition, cost comparisons showed a decrease in both length of stay and total cost per admission for patients undergoing ventriculoperitoneal shunt revision and lambdoidal suture synostectomy. CONCLUSIONS: Use of beds in the pediatric ICU was more efficient when a high-observation setting was available for low-risk monitored patients. Key differences in patterns of use were observed. Compared with the pediatric ICU, the monitored care unit requires fewer personnel and less expensive equipment and supplies, but it still allows potentially life-threatening complications to be recognized and treated. For patients who meet its admission criteria, the monitored care unit is a safe alternative to the pediatric ICU.