Cost containment: the pediatric perspective.

Pediatric critical care resource use in the United States is rapidly expanding despite low occupancy rates and organizational and leadership characteristics that suggest inefficient resource use in pediatric ICUs (PICUs). Studies confirm widespread inefficiencies. Use of PICU resources relates directly to severity of illness, and as a result mortality rates are directly related to efficiency rates. In addition, medical and social costs after PICU discharge are extensive, especially for long-term care of children left disabled by critical illness. Patients with acute illnesses requiring PICU care may account for > 20% of all profoundly retarded individuals. Neonatal ICU costs are driven up by the number of premature, low-birth-weight infants and treatment successes and failures, as well as the long-term functional status of patients. There are two strategies used in assessing the appropriate use of ICU resources: severity-adjusted length of stay and efficiency. Pediatric studies have focused more on efficiency evaluated on each day of ICU stay according to therapies used and severity of illness. If institutions are functioning in a very inefficient manner, a re-evaluation of admission and discharge criteria, as well as other hospital services, may be required to develop more efficient use of the PICU. The solution generally involves reducing the number of patients who are "too healthy to benefit." One intervention that has been successful in reducing resource use by these patients is a risk assessment program that contributes actual mortality risk information.(ABSTRACT TRUNCATED AT 250 WORDS)