Pollack M M, Cuerdon T C, Getson P R
Pediatric Intensive Care Unit, Children's Hospital National Medical Center, Washington, DC 20010.
Crit Care Med. 1993 Apr;21(4):607-14. doi: 10.1097/00003246-199304000-00023.
To describe the structure and organization of pediatric intensive care units (ICUs) in the United States.
We directed a mail survey to pediatric ICU medical and nursing directors and hospital quality assurance officers. A total of 201 of 301 hospitals with pediatric ICUs initially responded. Telephone confirmation of the mail survey (n = 193) and telephone data collection for mail survey nonresponders (n = 42) were also undertaken.
The largest proportion (40.0%) of pediatric ICUs had four to six beds per unit, while 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 intensivist 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 increased, as did the percentages with full-time directors, pediatric intensivists, and 24 hrs/day dedicated coverage. Medical school affiliation existed for 79.6% of pediatric ICU hospitals, and 81.1% of these hospitals were the primary teaching program sites for pediatrics. Other ICUs caring for children were present in 30.2% of the hospitals.
The mail survey respondents were stratified using four factors: size, teaching status, intensivist status, and coordination of care status. A total of 16 respondents were randomly selected for an ongoing outcomes study of the importance of these factors.
Substantial diversity exists in pediatric ICU structure and organization. Determining factors associated with quality of care is important for improving outcomes.
描述美国儿科重症监护病房（ICU）的结构和组织情况。
我们向儿科ICU的医疗和护理主任以及医院质量保证官员进行了邮件调查。301家设有儿科ICU的医院中，共有201家最初做出了回应。我们还对邮件调查进行了电话确认（n = 193），并对未回复邮件调查的对象进行了电话数据收集（n = 42）。
儿科ICU中最大比例（40.0%）的单位每单元有4至6张床位，而每单元床位> 18张的仅占6.0%。每年的入院人数平均为528±24，死亡率平均为5.5±0.2%。只有79.6%的儿科ICU有全职医疗主任。73.2%的单位有儿科重症医学专家。48.5%的医院有仅专门负责儿科ICU的每日24小时医生值班。随着ICU规模的增加，估计死亡率上升，全职主任、儿科重症医学专家以及每日24小时专门值班的比例也上升。79.6%的儿科ICU医院隶属于医学院，其中81.1%的医院是儿科学的主要教学项目基地。30.2%的医院有其他照顾儿童的ICU。
邮件调查的受访者根据四个因素进行分层：规模、教学状况、重症医学专家状况和护理协调状况。总共随机选择了16名受访者进行一项关于这些因素重要性的正在进行的结局研究。
儿科ICU的结构和组织存在很大差异。确定与护理质量相关的因素对于改善结局很重要。
