PEDIATRIC INTENSIVE-CARE UNITS - RESULTS OF A NATIONAL SURVEY

Objective. To describe the structure and organization of pediatric int ensive care units (ICUs) in the United States. Survey Methods. We dire cted a mail survey to pediatric ICU medical and nursing directors and hospital quality assurance officers. A total of 201 of 301 hospitals w ith pediatric ICUs initially responded. Telephone confirmation of the mail survey (n = 193) and telephone data collection for mail survey no nresponders (n = 42) were also undertaken. Survey Results. The largest proportion (40.0%) of pediatric ICUs had four to six beds per unit, w hile only 6.0% had >18 beds per unit. The admissions per year averaged 528 +/- 24, and the mortality rates averaged 5.5 +/- 0.2%. Only 79.6% of the pediatric ICUs had full-time medical directors. A pediatric in tensivist was available to 73.2% of the units. Physician coverage for 24 hrs/day dedicated only to the pediatric ICU was present in 48.5% of hospitals. As ICU size increased, the estimated mortality rates incre ased, as did the percentages with full-time directors, pediatric inten sivists, and 24 hrs/day dedicated coverage. Medical school affiliation existed for 79.6% of pediatric ICU hospitals, and 81.1% of these hosp itals were the primary teaching program sites for pediatrics. Other IC Us caring for children were present in 30.2% of the hospitals. Survey Application: The mail survey respondents were stratified using four fa ctors: size, teaching status, intensivist status, and coordination of care status. A total of 16 respondents were randomly selected for an o ngoing outcomes study of the importance of these factors. Conclusions: Substantial diversity exists in pediatric ICU structure and organizat ion. Determining factors associated with quality of care is important for improving outcomes.