Patient Characteristics and Prevalence of Unplanned Postoperative Pediatric Intensive Care Unit Admissions

Abstract

Objectives:

The aim of this study was to identify the prevalence of unplanned postoperative pediatric intensive care unit (PICU) admissions (UPPAs) and associated patient characteristics.

Design:

A retrospective, descriptive study at a single institution was conducted from January 1, 2011, to December 31, 2014. Trauma, medical, and weekend admissions were excluded. In addition, cardiac, orthopedic, and urology surgical admissions were excluded. A derived disability level was calculated using the baseline Pediatric Overall and Cognitive Performance Criteria. Mortality risk and acuity scores were compared between UPPAs and planned PICU admissions (PPAs). Outcomes as a function of patient origin (operating room [OR], postanesthesia care unit [PACU], and acute care floor [ACF]) and surgical services were compared.

Setting:

This study was conducted in a free-standing, tertiary care children's hospital.

Patients:

Patients admitted to the PICU within 24 hours following an operative procedure.

Measurements and Main Results:

There were 158 (34%) UPPAs. Compared with postoperative PPAs, UPPAs had higher acuity and mortality scores (p < .05). UPPAs were highest from the OR (58%), followed by those from the PACU (PACU-UPPA, 27%) and ACF (13%). There was no difference in the odds of UPPAs from the OR among surgical services. There was increased odds of PACU-UPPA after otolaryngology (odds ratio = 1.15, p < .0001) and pediatric surgery (odds ratio = 2.19, p < .0001) and the presence of disability (odds ratio = 3.67, p = .011). None of the variables were associated with UPPAs from the ACF.

Conclusions:

This study identified surgical services and moderate disability as independent risk factors for UPPA. PACU-UPPA may represent an improvement opportunity. It is feasible to derive a risk stratification model for UPPA.

Keywords

patient disposition postoperative unplanned admissions

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References

Darley

J. M.

& Latané

(1968). Bystander intervention in emergencies: Diffusion of responsibility. Journal of Personality and Social Psychology, 8(4), 377–383.

da Silva

P. S.

de Aguiar

V. E.

& Fonseca

M. C.

(2013). Risk factors and outcomes of unplanned PICU postoperative admissions: A nested case-control study. Pediatric Critical Care Medicine, 4(14), 420–428.

El Halal

M. G.

Barbieri

Filho

R. M.

Trotta Ede

& Carvalho

(2012). Admission source and mortality in a pediatric intensive care unit. Indian Journal of Critical Care Medicine, 16(2), 81–86.

Gandhi

Sangareddi

Varadarajan

& Suresh

(2013). Pediatric index of mortality 2 score as an outcome predictor in pediatric Intensive Care Unit in India. Indian Journal of Critical Care Medicine, 17(5), 288–291.

Gibson

A. R.

Limb

& Bell

(2014). Retrospective audit of unplanned admissions to pediatric high dependency and intensive care after surgery. Pediatric Anesthesia, 24(4), 372–376.

Haller

Myles

P. S.

Wolfe

Weeks

A. M.

Stoelwinder

& McNeil

(2005). Validity of unplanned admission to an intensive care unit as a measure of patient safety in surgical patients. Anesthesiology, 103(6), 1121–1129.

Harkins

& Jackson

(2014). The hidden traps of decision making. Personality and Social Psychology, 11(5), 457–469.

Henriksen

& Dayton

(2006). Organizational silence and hidden threats to patient safety. Health Services Research, 41(4, Pt. 2), 1539–1554.

Homsted

(2000). Institute of Medicine report: To err is human: Building a safer health care system. FLA Nurse, 48(1), 6.

10.

Institute of Medicine. (1999). To err is human: Building a safer health system. Retrieved from http://www.nationalacademies.org/hmd/∼/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

11.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved from http://www.nap/edu/books/0309072808/html/

12.

Kurowski

& Sims

(2007). Unplanned anesthesia-related admissions to pediatric intensive care - a 6-year audit. Pediatric Anesthesia, 17(6), 575–580.

13.

Leary

& Forsyth

(1987). Attributions of responsibility for collective endeavors. Review of Personality and Social Psychology, 8, 167–188.

14.

Lee

T. H.

(2006). Can we cross the quality chasm? The case for realistic optimism. American Heart Hospital Journal, 4(1), 16–19.

15.

Leteurtre

Martinot

Duhamel

Proulx

Grandbastien

Cotting

… Leclerc

(2003). Validation of the paediatric logistic organ dysfunction (PELOD) score: Prospective, observational, multicentre study. Lancet, 362(9379), 192–197.

16.

National Institutes of Health. (n.d.). Retrieved from https://www.nlm.nih.gov/hsrinfo/datasites.html

17.

Odetola

F. O.

Rosenberg

A. L.

Davis

M. M.

Clark

S. J.

Dechert

R. E.

& Shanley

T. P.

(2008). Do outcomes vary according to the source of admission to the pediatric intensive care unit? Pediatric Critical Care Medicine, 9(1), 20–25.

18.

Osinaike

Adeninto

(2010). Intensive care admissions of patients following surgery. Retrieved from https://www.researchgate.net/publication/272325762_Intensive_care_admissions_of_patients_following_surgery

19.

Pedreira

M. L.

(2011). The art of nursing: Crossing the quality chasm and promoting patient safety in critical care. Nursing Critical Care, 16(4), 150–160.

20.

Pollack

M. M.

Patel

K. M.

& Ruttimann

U. E.

(1996). PRISM III: An updated pediatric risk of mortality score. Journal of Critical Care Medicine, 25(5), 743–752.

21.

Tatic

Gvozdenovic

Maskovic

& Vojnovic

(2014). Importance of Pediatric Scoring Systems of Mulitorgan Failure in the Intensive Care Unit. Global Journal of Medical Research, 14(2), 118–120.

22.

Tiegen

K. H.

& Brun

(2011). Responsibility is divisible by two, but not three or four: Judgements of responsibility in dyads and groups. Social Cognition, 29, 15–42.

23.

Wallach

M. A.

Kogan

& Bem

D. J.

(1962). Group influence on individual risk taking. Journal of Abnormal and Social Psychology, 65, 75–86.