Paediatric Intensive Care, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, UK.
Arch Dis Child. 2012 Nov;97(11):943-6. doi: 10.1136/archdischild-2011-301310. Epub 2012 Jul 4.
Prompted by high refused admission rates, we sought to model demand for our 20 bed paediatric intensive care unit.
We analysed activity (admissions) and demand (admissions plus refused admissions). The recommended method for calculating the required number of intensive care beds assumes a Poisson distribution based upon the size of the local catchment population, the incidence of intensive care admission and the average length of stay. We compared it to the Monte Carlo method which would also include supra-regional referrals not otherwise accounted for but which, due to their complexity, tend to have a longer stay than average. For the new method we assigned data from randomly selected emergency admissions to the refused admissions. We then compared occupancy scenarios obtained by random sampling from the data with replacement.
There was an increase in demand for intensive care over time. Therefore, in order to provide an up-to-date model, we restricted the final analysis to data from the two most recent years (2327 admissions and 324 refused admissions). The conventional method suggested 27 beds covers 95% of the year. The Monte Carlo method showed 95% compliance with 34 beds, with seasonal variation quantified as 30 beds needed in the summer and 38 in the winter.
Both approaches suggest that the high refused admission rate is due to insufficient capacity. The Monte Carlo analysis is based upon the total workload (including supra-regional referrals) and predicts a greater bed requirement than the current recommended approach.
由于高拒诊率，我们试图为我们的 20 张儿科重症监护病房床位建模需求。
我们分析了活动（入院）和需求（入院加拒诊）。计算所需重症监护床位数量的推荐方法基于当地人群的大小、重症监护入院的发生率和平均住院时间，假设泊松分布。我们将其与蒙特卡罗方法进行了比较，后者还包括未被其他方式考虑到的超区域转诊，但由于其复杂性，平均停留时间往往更长。对于新方法，我们将随机选择的紧急入院数据分配给拒诊。然后，我们比较了从数据中随机抽样并替换的入住场景。
随着时间的推移，对重症监护的需求有所增加。因此，为了提供最新的模型，我们将最终分析仅限于最近两年的数据（2327 例入院和 324 例拒诊）。传统方法建议 27 张床可满足 95%的需求。蒙特卡罗方法显示 34 张床符合 95%的要求，季节性变化量化为夏季需要 30 张床，冬季需要 38 张床。
两种方法都表明高拒诊率是由于容量不足所致。蒙特卡罗分析基于总工作量（包括超区域转诊），并预测所需床位数量大于当前推荐方法。
