Stambouly J J, Pollack M M, Ruttimann U E
Department of Critical Care Medicine, Children's National Medical Center, Washington, DC.
Intensive Care Med. 1991;17(3):154-8. doi: 10.1007/BF01704719.
Rationing of pediatric intensive care beds occurs when the severity of illness of patients admitted to and discharged from the PICU is inversely proportional to the number of available PICU beds. Bed rationing may also increase the proportion of patients using unique PICU therapies, thereby increasing efficiency. Consecutive PICU admissions (n = 283) were evaluated for three months for descriptive data, daily severity of illness, and daily care modalities. PICU and hospital censuses were also recorded. The mean PICU occupancy was 75% (range 37.5%-100%), the hospital occupancy was 79% (range 60%-96%) and the daily PICU efficiency was 78% (range 50%-100%). The PICU census was greater than 90% on 13% of the study days. Neither PICU nor hospital census was associated with the severity of illness of patients admitted to or discharged from the PICU. Severity of illness for patients admitted when only one bed was available or discharged when there were no available beds was not higher than at other times. Therefore, we did not find evidence of rationing of pediatric intensive care by using quantitative methods. As health care funding becomes more limited, quantitative analyses such as this study differentiating the need for more PICU beds from the need for better PICU bed utilization will be beneficial.
当儿科重症监护病房（PICU）收治和转出患者的疾病严重程度与可用PICU床位数量成反比时，就会出现PICU床位的分配问题。床位分配也可能会增加使用PICU独特治疗方法的患者比例，从而提高效率。对连续三个月的PICU入院患者（n = 283）进行评估，以获取描述性数据、每日疾病严重程度和每日护理方式。同时记录PICU和医院的普查数据。PICU的平均占用率为75%（范围为37.5%-100%），医院占用率为79%（范围为60%-96%），每日PICU效率为78%（范围为50%-100%）。在13%的研究日中，PICU普查率大于90%。PICU或医院普查率与PICU收治或转出患者的疾病严重程度均无关联。在只有一张床位可用时入院或没有可用床位时转出的患者，其疾病严重程度并不高于其他时间。因此，我们没有发现使用定量方法进行儿科重症监护床位分配的证据。随着医疗保健资金变得更加有限，像本研究这样区分对更多PICU床位的需求和对更好地利用PICU床位的需求的定量分析将是有益的。
