PICU/TCU Survey Results January 2001 Prepared by Strategic & Business Planning

PICU/TCUPICU/TCUSurvey ResultsSurvey Results

January 2001Prepared by Strategic & Business Planning

PICU/TCU SurveyPICU/TCU Survey

• A total of sixteen surveys were completed by various children’s hospitals

• The majority of hospitals surveyed (56%) indicated that they had some type of step-down unit associated with the PICU

• All of the hospitals surveyed (100%) stated that the PICU was used for both intubated and unintubated patients

PICU/TCU SurveyPICU/TCU SurveyQ2. Criteria Used to determine transfer form PICU to step-down unit

At the discretion of the PICU attending, but basically stableairway, off pressors, not deteriorating.

Criteria covers multiple aspects so if you want the specifics Iwould be glad to fax to you if you will send me your faxnumber.

The PIMCU has admission guidelines, but (like anything else)they do not necessarily apply in all cases. Basically, if the childis physiologically stable (extubated, off all pressors, etc.) butneeds monitoring or more intensive nursing, respiratory care ormedical attention that is available on the general care units, s/hewould be tranferred or admitted to that service. Sometimes, it’sthat child who could use “one more day” of monitoring whenthe beds fill and we need space. Since our general care units arelocated in another building, we sometimes admit to thatprogram if the docs think that the child might well land in thePICU within a short time period, but aren’t sure enough to justadmit to us from the start. I know that’s a long answer, but it’sa complicated and political topic around here.

PICU/TCU SurveyPICU/TCU SurveyQ2. Criteria Used to determine transfer form PICU to step-down unit

When acute intervention is unlikely and observation is mostimportant. We do tonic inotropes in TCU, some complexsedation/pain control, post ops not intubated, etc.

All interventions must be q4h or less often, no/Ivgtts (PCA isok), hemodynamically stable, and no monitering needs (apneamoniters are ok).

Intensivist discretion If on a vent, they need to have a trach and tolerate a simple vent,

such as sechrist or newport. If not on a vent, they must behemodyamically stable and either need only 48 hours more ofintensive monitoring or be considered a “TCU Candiates”requiring the full services of the TCU, i.e. a team of health caregivers and a potential for neurological rehabilitation.

PICU/TCU SurveyPICU/TCU SurveyQ4. What is the level of care on your surgical units?

Generally very good We do not have any surgical unit designations We have a general pediatric unit that takes surgical patients that

are non-ventilated and require less frequent than q2hourmonitoring of vital signs.

The level of care varies dependent on the surgical specialty.I’m not sure what you mean by this… Most of our surgical casesgo th the PAVU and then to a general surgical unit. Only thosewith specialized needs or with a strong possibility of problemswould come to us. I wish I could be more specific…if you’reinterested in whether certain kinds of surgical patients do or do notcome to the PICU, I would be able to tell you. If that is the case,just let me know.

PICU/TCU SurveyPICU/TCU SurveyQ4. What is the level of care on your surgical units?

High- but it is still the only area we have to send pts. Timestaffing inferior in these areas.

We have PICU and General Peds only.Level I 1% of patients 1:1Level II 10% of patients 1:2Levell III 75% of patients 1:3Level IV 14% of patients 1:4 and greater

General med/surg floor that takes most general surgery patientswho require typical floor care.

Post op trachs can go to our surgical floors if that is the onlything they need. This happens 24 hours after the trach is placed.Inotropes and invasive monitors are restricted to the ICU andTCU

PICU/TCU SurveyPICU/TCU SurveyQ5. Where would the following patient be cared for?

PICU88%

Surgical Unit12%

Q5a.16 yr old with multiple trauma, fractured pelvis, head injury not requiring intervention, fractured liver, q4h amylase levels, PCA pump for pain control

N=16


PICU88%

Medical Unit12%

Q5b.12 yr old newly diagnosed diabetic, requiring q1h VS, q1h glucose levels, change of IVF rate q1-2h

N=16


PICU51%

Other12%

Med/Surg Floor25%

TCU12%

Q5c. 1 yr old with viral pneumonia, with history of 32 wk birth, consequent chronic lung disease, cerebral palsy, trach, g-tube, requiring complete care of ADL, q3h g-tube feeds, numerous

g-tube meds, q2h albuterol treatments, trach suctioning q30min-q1h

N=16


PICU60%

Surgical Floor20%

TCU20%

Q5d. 14 yr old with previous history of cervical spine injury, leaving him with little movementof one arm and hand, requiring complete ADL care, has now had GI surgery, and has developed

electrolyte and clotting problems. He has an NGT to LWS, a foley catheter, a central line through which he requires triple antibiotics, TPN and IL, is receiving vitamin K, requires lab draws q2h with subsequent electrolyte adjustments. The surgeon wants him out of bed at least 3 times daily and q2h, incentive inspirometry

to prevent surgical complications of pneumonia

N=10


PICU19%

Burn Unit50%

Transfer Out19%

TCU12%

Q5e. Toddler with 40% TBSA scald burns, requiring BID dressing changes, qd tubbing, PCA pump,NJ feeds, calorie count

N=16


PICU75%

Other6%

Surgical Unit19%

Q5f. 15 yr old post-op spinal surgery with chest tube, foley catheter, epidural pain control,requires q2h turning, q2h vital signs, urine and CT output, q2h incentive inspirometry

N=16


PICU50%

CCU38%

TCU12%

Q5g. 4 month old with SVT, on telemetry

N=16

Documents

PICU/TCU Survey Results January 2001 Prepared by Strategic & Business Planning