(1350) Does My Patient Need the Pediatric Intensive Care Unit (PICU)? Assessing PICU Admission Reasons

Introduction: Guidelines for Pediatric Intensive Care Unit (PICU) admissions are based on many factors such as patient condition, and bed/staffing availability. The American Academy of Pediatrics provides overall guidance for PICU admissions but requires tailoring to the local context. Providing the appropriate level of monitoring ensures we provide timely, safe, effective, and efficient care. We aimed to gauge knowledge of reasons for required PICU medical admission in our local context.

Methods: We surveyed providers—including residents, fellows, attendings, and advanced practice practitioners (APPs)—in critical care, hospital medicine, emergency room, and pediatric medical subspecialties. We included domains for required PICU admission such as respiratory support and device needs. Respondents were asked whether a specific scenario within their scope of practice required PICU admission based on our current hospital policies and procedures. We used a threshold of 30% for an incorrect answer.

Results: Overall, 123 responses were received, with almost half of these (61/123) from attendings. The number of respondents varied by question.

Respiratory support: Over 30% of respondents incorrectly selected the following as a requirement for PICU admission: non-rebreather mask, oxymask >10LPM, home BiPAP/CPAP on home settings. Over 30% incorrectly believed POD 0 on home BiPAP/CPAP settings and PEP treatments q2 hours did not require the PICU.

Device needs: Over 30% of respondents incorrectly selected the following items as requiring a PICU admission: mediastinal chest tube, pericardial drain, IJ line, and Bair Paws warming device.

Medication needs: Over 30% of respondents incorrectly selected the following items as requiring a PICU admission: IV Ca bolus, octreotide infusion, and a Bumex infusion.

Conclusions: Much misinformation exists as to what requires a PICU admission. Our current providers favor a more “conservative” approach for admission given that most incorrect responses were that patients required the PICU when they currently do not. Device needs and respiratory support had the most incorrect responses. We can use this data to tailor our PICU admission guidelines and provide targeted education.