PCC Occupancy Data to Support External Review

Summary

• This report provides an overview of the occupancy rates for the paediatric critical care unit (PCCU) at the John Radcliffe Hospital
• The main findings are:
• The average occupancy rate for the PCCU was 85%, which is above the national benchmark of 80%.
• The occupancy rate varied by month, season, and day of the week, with the highest rates in winter and on weekdays.
• The main factors affecting occupancy were the number and severity of admissions, the availability and suitability of beds, and the discharge and transfer processes.
• Occupancy significantly decreased during the COVID pandemic but has now surpassed pre-pandemic levels.
• An increasing proportion of overall capacity is being occupied by technology-dependent patients with complex needs and prolonged stays.

Background

• PICU at the John Radcliffe Hospital is an 17-bed unit that provides intensive care for children aged 0 to 16 years.
• PICU is currently externally commissioned for 9 HDU beds (Level 1 and 2 care) and 8 ICU beds (Level 3 and 4 care).
• PICU is currently located on Level 3 of the Oxford Critical Care (OCC) building after an extensive options appraisal supported by the trust executive taking place over the year prior to the move.
  
• PICU is part of the regional network of paediatric critical care services, which means that it accepts referrals from other hospitals within the Thames Valley and Wessex region.
• The purpose of this report is to summarise occupancy rates for the PCCU over the past 10 years to support the external review process
• The data used for the analysis were obtained from the PCCU ‘Medicus’ database, which exports data to the national PICU audit (PICANET) and represents the local version of the same data. The database records the daily admission and discharge information for each patient, including the date, time, diagnosis, severity, length of stay, and outcome.
• The data were extracted for the period from Jan 2014 to Dec 2024
• The time-period also includes data acquired during the COVID pandemic where there was a significant drop of in PCCU activity nationwide. This was more than compensated for by the admission of unwell adults to PCCU (not captured in this dataset).
• The occupancy rate was calculated as the ratio of the number of occupied beds to the total number of available beds, expressed as a percentage.
• The occupancy rate was calculated for each day, month, season, and day of the week, and compared with the national benchmark of 80%, which is the recommended level of occupancy for optimal efficiency and quality of care. Working above this level would normally trigger the national OPEL escalation system [link here].

Results

• Overall admissions stay roughly steady at between 700 and 850 per year. Since the expansion of the retreival service in 2022 the proportion of admissions that are external has increased from roughly a third to around half of all admissions.

PICU Admissions by Source
2015–2024
Year	Internal	External	Total
2015	626	219	845
2016	661	190	851
2017	584	174	758
2018	646	175	821
2019	581	166	747
2020	402	125	527
2021	512	190	702
2022	505	222	727
2023	506	221	727
2024	458	245	703

• Occupancy rates are overall high

• The table shows that in the year before and the 2 years after the COVID-19 pandemic mean and median occupancy ran at > 80% which should trigger an escalation in OPEL levels regionally.

• In 2022 although occupancy was lower at the beginning of the year we saw a huge peak in winter admissions due to resurgence of infectious pathogens (predominately influenza and group A streptococcus). This is reflected in the highest maximum occupancy (171%) in November 2022. At this time most of the country’s PICU beds were full and the system was almost overwhelmed with children waiting long times in district hospitals for PCC beds to become available and travelling long distances to find a bed.

• the following graph displays this graphically per bed day with days >80% occupancy colored red

To consider which are the busiest months it is useful to look at aggregate data for each month over the period studied. As already stated occupancy of PICU with paediatric patients significantly decreased during the COVID pandemic. As this is exceptional we have excluded these years (2020/2021) in the following analysis so as not to artificially skew the numbers. The data is represented in tabular form….

PCC Occupancy by month in 2019 (Excluding Coivd Pandemic)

Month	Median Occupancy	Maximum Occupancy
Jan	82 %	118 %
Feb	82 %	112 %
Mar	82 %	171 %
Apr	82 %	118 %
May	76 %	118 %
Jun	82 %	118 %
Jul	76 %	118 %
Aug	59 %	129 %
Sep	71 %	106 %
Oct	82 %	129 %
Nov	94 %	129 %
Dec	88 %	124 %

… and in graphical form:

Another useful way of displaying the data is to look at the number of days every month when occupancy reaches pre-set thresholds. For this purpose a representaitve year (2019) has been chosen and the days over threshold calculated for each month.

Month	Days in month where Occupancy > 80%	Days in month where Occupancy > 100%
Jan	22	4
Feb	27	10
Mar	29	8
Apr	28	7
May	15	3
Jun	19	1
Jul	4	0
Aug	1	0
Sep	14	1
Oct	28	10
Nov	30	16
Dec	31	14