Number Of Available Beds Research Articles

Trends in stroke admissions to a Tanzanian hospital over four decades: a retrospective audit.

The aim of this study was to record stroke admissions to a tertiary referral hospital in Tanzania over four decades. We audited the medical records held at a large teaching and tertiary referral hospital in northern Tanzania over four decades. We collected records for the years 1974-1976, 1984-1986, 1994-1995 and 2008. All patients admitted as inpatients with a primary diagnosis of stroke were included in the study. Data collected included age, sex, stroke subtype, predominant side of symptoms and survival to discharge. The number of stroke admissions rose from just four in the three-year period 1974-1976 (mean 1.3 cases annually) to 153 cases annually in 2008. The mean age of those admitted rose steadily during this period, as did the proportion of females admitted. The burden of stroke on health services in Tanzania appears to have increased rapidly. If this increase is to be slowed, then sustainable primary preventative measures to target known stroke risk factors will be required.

Out of sight, out of mind: mental illness behind bars.

Out of sight, out of mind: mental illness behind bars.

Mass Casualty of Scombroid Fish Poisoning among Factory Workers in Obour City

On the first of January 2013 one hundred and seventy five workers in one of El Obour factories were complaining of nausea, vomiting, abdominal cramps and diarrhea after eating a mackerel fish lunch meal served to them at their work at 1 P.M. They were rushed first to emergency department “ED” of El Salam general hospital where they were diagnosed as food poisoning and advised to be transported to the poison control center “PCC” of Ain Shams University “ASU.” The faculty dean and PCC director alerted the preventive control unit in ministry of health about suspected scombroid food poisoning. An emergencymanagement plan for mass casualty was established. The patients were triaged under supervision of two clinical toxicologist teams and grouped according to triage colored tags into yellow tag cases (Group I) ;they included 65 cases with mild clinical manifestations. Green tag cases (Group II); they included 100 cases with moderate manifestations and red tag cases (Group III); they included10cases presented withsevere clinical manifestations. Demographic data showed that 60% were males and 40% were females .There was non-significant statistical difference regarding delay time between the three studied groups. The clinical assessment results revealed highly significant statistical difference between the studied groups regarding gastrointestinal manifestations (in the form of diarrhea, abdominal colic, and tingling and burning peppery taste sensation), and cardiopulmonary manifestations (in the form of hypotension, tachycardia, bronchospasm, positive Trendelenberg´s position). Neurological manifestations in the form of headache were highly significant in the studied groups and significant syncope only in group III. The skin manifestations among the studied groups showed highly statistical significant facial flushing, sweating and itching. Microbiological examination of biological samples (stool and gastric aspirate) and fish samples (fried and raw mackerel fish) revealed positive Bacillus cereus and Staphylococcus aureus. Chemical examination of fish samples revealed highly significant increase in histamine levels in fried and raw mackerel fish samples when compared with their permissible levels according to food and drug administration values. There was highly significant statistically difference between the studied groups of patients with acute scombroid fish poisoning as regards the percentage of different lines of treatment received at emergency room and inpatient wards of both PCC and ED ASU hospitals. The outcome showed complete cure with fully discharged cases with no morbidities or mortalities. In conclusion mass casualty of scombroid fish poisoning incident could pass safely if the emergency management plan was successfully established. The study recommends the necessity of increasing the number of available beds in PCC to enlarge its capabilities of facing mass casualty incidents. Also the study recommends the necessity of strict preservation of fish especially those belonging to scombroidea family (mackerel and tuna) in cool temperature to avoid bacterial contamination and the increase in histamine level.

Clustering clinical departments for wards to achieve a prespecified blocking probability

When the number of available beds in a hospital is limited, it can be beneficial to cluster several clinical departments such that the probability of not being able to admit a patient is acceptably small. However, not all clinical departments can be clustered for cross-infection reasons. In addition, patients from one clinical department should not be spread out over the entire hospital as this complicates the process of doing rounds and may result in alternate level of care. In this paper, we consider a situation where wards with a fixed number of beds are given. The question is how to cluster the clinical departments and to determine the assignment of these clustered departments to the available wards such that the assigned beds are sufficient to guarantee a blocking probability below a prespecified percentage. We first give an exact formulation of the problem to be able to achieve optimal solutions. However, computational experiments show that the resulting computation times for this model are too long for it to be applicable in practice. To reduce the computation time, we introduce two heuristic solution approaches. The first heuristic uses the same formulation as the exact model, however, the number of required beds is approximated by a linear function. The resulting model is again solved by an exact solver. The second heuristic uses a restricted version of the exact model within a local search approach. Hereby, the local search is used to determine the assignment of clinical departments to clusters and the exact model is used to determine the assignment of clusters to wards.

Triage of Patients Consulted for ICU Admission During Times of ICU-Bed Shortage.

BackgroundThe demand for specialized medical services such as critical care often exceeds availability, thus rationing of intensive care unit (ICU) beds commonly leads to difficult triage decisions. Many factors can play a role in the decision to admit a patient to the ICU, including severity of illness and the need for specific treatments limited to these units. Although triage decisions would be based solely on patient and institutional level factors, it is likely that intensivists make different decisions when there are fewer ICU beds available. The objective of this study is to evaluate the characteristics of patients referred for ICU admission during times of limited beds availability.MethodsA single center, prospective, observational study was conducted among consecutive patients in whom an evaluation for ICU admission was requested during times of ICU overcrowding, which comprised the months of April and May 2014.ResultsA total of 95 patients were evaluated for possible ICU admission during the study period. Their mean APACHE-II score was 16.8 (median 16, range 3 - 36). Sixty-four patients (67.4%) were accepted to ICU, 18 patients (18.9%) were triaged to SDU, and 13 patients (13.7%) were admitted to hospital wards. ICU had no beds available 24 times (39.3%) during the study period, and in 39 opportunities (63.9%) only one bed was available. Twenty-four patients (25.3%) were evaluated when there were no available beds, and eight of those patients (33%) were admitted to ICU. A total of 17 patients (17.9%) died in the hospital, and 15 (23.4%) expired in ICU.ConclusionICU beds are a scarce resource for which demand periodically exceeds supply, raising concerns about mechanisms for resource allocation during times of limited beds availability. At our institution, triage decisions were not related to the number of available beds in ICU, age, or gender. A linear correlation was observed between severity of illness, expressed by APACHE-II scores, and the likelihood of being admitted to ICU. Alternative locations outside the ICU in which care for critically ill patients could be delivered should be considered during times of extreme ICU-bed shortage.

Análisis de la eficiencia técnica hospitalaria 2011

Efficiency in the use of resources in health systems and hospitals has been a matter of interest for administrators as well as for policy makers. The growing costs due to higher levels of demand from the population require a better use and allocation of such costs. To assess the technical efficiency in 28 hospitals in Chile, considering the period from May to October, 2011. The average number of available beds, the number of staff and the expenses on consumer and service goods were used as production inputs and, on the other hand, the expenditures adjusted by the Diagnosis-Related Groups (IR-DRG) were used as producís. To assess the technical efficiency, the Data Envelopment Analysis technique was used. The levéis of inefficiency fluctuóte from 20 to 23.3%. In other words, with a 20% increase in hospital discharges and maintaining fixed inputs, hospitals could become efficient. The incorporation of methodologies to determine efficiency allows gathering new knowledge for people who manage resources as well as for policy makers by optimizing practices and having better allocation criteria.

Abstract WP351: Using Standard Work to Improve the Discharge Process on a Neurology Division

Background and Issues: Patient volume increased significantly over first half of 2011 on the Neurology Service. Bed occupancy increased by 14% over previous year and bed availability became a major constraint. Data showed, patients were discharged late in the day or sometimes stayed an extra night because discharge orders were released too late to place patients in rehab or skilled nursing facilities. Only 16% of patients were discharged by 2:00 pm due to communication barriers and inadequate information exchanged between multidisciplinary teams. There was also an issue with inconsistent acceptance criteria from primary placement facilities which resulted in a longer length of stay. Purpose: Primary goal of project was to free up capacity on the Nursing Division to accommodate the increase in patient volumes without increasing staffing or the number of available beds. Methods: In September 2011, a multidisciplinary team was assembled to understand causes of the problems and develop solutions to resolve. Solutions implemented include working with partner Rehab and Skilled Nursing Facilities to define standardized Acceptance Guidelines to ensure issues could be addressed before day of discharge. Also, processes for releasing discharge orders were redesigned so orders were more frequently written and placed “on hold” the day before expected discharge. A mobile computer was issued to physician rounding teams so orders could be released during rounds instead of batch-released in the afternoon. Additionally, team communication was significantly improved by standardizing a daily multidisciplinary team huddle and implementing a visual communication board to track key information about patients to proactively plan for discharge. Results: The overall length of stay of patients on the Neurology Service decreased from 4.26 days in 2011 to 3.69 days in 2012. Conclusions: Many variables contributed to the decrease in length of stay for patients in this study. No decisive conclusions can be made about the effectiveness of any particular variable. Other variables during this timeframe likely contributed, however the authors of this study presented the most likely factors. Although the findings are exciting, further analysis is needed to isolate the main drivers.

Performance of Neonatal Unit, Arifin Achmad Hospital, Pekanbaru

Background Arifin Achmad Hospital is the largest hospital inRiau Province, Indonesia, which serves as referral hospital andoffers tertiary care for sick neonates.Objective To review the performance of the Neonatal Unit ofArifin Ahmad Hospital as a mean to further improve the overallcare Mth specific interest to improve neonatal outcomes.Methods We collected the clinical data of all patients admitted tothe Neonatal Unit from 2008 to 2010. Diagnoses were classifiedaccording to the International Statistical Classification of Diseasesand Related Health Problems 10th Revision (Revised leD 10). Weevaluated the overall performance of the unit, including numberof beds, number of patients, and bed occupancy rates (BOR). Thespectrum of diagnoses was also described. Associations betweenclinical characteristics and patient outcomes were analyzed usingunivariate Chi square test.Results The number of available beds increased from 10 beds in2008 to 24 beds in 2010, thereby decreasing the BORfrom 112%in 2008 to 82% in 2010, despite the yearly increase in numberof patients (702 in 2008, 772 in 2009, and 821 in 2010). MostNeonatal Unit patients were male, aged 0􀁒3 days at the time ofadmission, had birth weights of 2500􀁒4000 grams, born in RSUDArifin Achmad and were born vaginally. Respiratory problems,prematurity and infections were the three main reasons foradmission. Birth weight, the presence of congenital malformations,referral status, and < 7 day length of stay were associated withmortality.Conclusions The performance of the unit increased during the3􀁒year period of study. Most patients admitted had respiratoryproblems, fetal growth problems, or infections. We found that birthweight, congenital malformations, referral status, and decreasedlength of stay were prognostic factors for patient outcomes.[Paediatr rndones. 2012;52:356-61].

Performance of Neonatal Unit, Arifin Achmad Hospital, Pekanbaru

Background Arifin Achmad Hospital is the largest hospital inRiau Province, Indonesia, which serves as referral hospital andoffers tertiary care for sick neonates.Objective To review the performance of the Neonatal Unit ofArifin Ahmad Hospital as a mean to further improve the overallcare Mth specific interest to improve neonatal outcomes.Methods We collected the clinical data of all patients admitted tothe Neonatal Unit from 2008 to 2010. Diagnoses were classifiedaccording to the International Statistical Classification of Diseasesand Related Health Problems 10th Revision (Revised leD 10). Weevaluated the overall performance of the unit, including numberof beds, number of patients, and bed occupancy rates (BOR). Thespectrum of diagnoses was also described. Associations betweenclinical characteristics and patient outcomes were analyzed usingunivariate Chi square test.Results The number of available beds increased from 10 beds in2008 to 24 beds in 2010, thereby decreasing the BORfrom 112%in 2008 to 82% in 2010, despite the yearly increase in numberof patients (702 in 2008, 772 in 2009, and 821 in 2010). MostNeonatal Unit patients were male, aged 0ô€’3 days at the time ofadmission, had birth weights of 2500ô€’4000 grams, born in RSUDArifin Achmad and were born vaginally. Respiratory problems,prematurity and infections were the three main reasons foradmission. Birth weight, the presence of congenital malformations,referral status, and < 7 day length of stay were associated withmortality.Conclusions The performance of the unit increased during the3ô€’year period of study. Most patients admitted had respiratoryproblems, fetal growth problems, or infections. We found that birthweight, congenital malformations, referral status, and decreasedlength of stay were prognostic factors for patient outcomes.[Paediatr rndones. 2012;52:356-61].

State of psychiatry in Denmark

Danish psychiatry has gone through profound changes over the past two to three decades, reducing inpatient-based treatment and increasing outpatient treatment markedly. The number of patients treated has almost doubled, and the diagnostic profile has broadened, now including a substantial number of common mental disorders, in particular depression and anxiety. Furthermore, ‘new’ diagnostic groups are represented in the treatment statistics with steeply increasing incidences, e.g. attention deficit hyperactivity disorder (ADHD) and eating disorders, especially in the outpatient part of the statistics. Over the same 30 years, the number of available beds has been reduced by 60–70%; however, as the length of stay of inpatients has been reduced markedly, the departments are still able to treat a high number of patients. The financial budgeting of psychiatry is not increasing equivalently to the somatic specialities, handicapping development in psychiatry. Action has been taken to increase research activity in psychiatry. This is facilitated by an increasing interest among medical students and young graduate physicians attracted by the neuropsychiatric paradigm, rapidly implemented in Danish psychiatry.

Volatility in bed occupancy for emergency admissions

The volatility associated with the average bed occupancy for emergency admissions is shown to follow complex long-term patterns. Such patterns in volatility arise from the interaction between the environment and human physiological and immunological processes. Hospital average bed occupancy should be sufficient to cope with the periods associated with maximum amplitude in volatility and it is at this point that current methods for sizing hospitals are woefully inadequate. By implication hospitals should be built with a higher number of available beds than in current practice. Supporting methodologies need to be developed to allow hospital managers to staff the occupied beds in a predictive manner rather than the available beds, to minimise staff costs but maximize patient care.

Dealing with the mentally ill in the criminal justice system in Germany

Mentally disordered prisoners in Germany are subject to special legal regulations, which can be traced back to the 1933 “Dangerous Habitual Offenders and their Detention and Rehabilitation Act”. There are no special diversion programs in Germany but diversion does in fact happen via legal regulations that are based on the construct of legal responsibility. Diversion refers to the removal of offenders from the criminal justice system at any stage of the procedure and court proceedings. In recent years the number of occupied beds in forensic psychiatric hospitals has continued to rise. At the same time the number of people in prisons has slightly decreased while there has been a slight increase in the number of available beds in general psychiatry. Germany experienced public and media concern about the risk posed by conditionally released mentally ill offenders and other perceived inadequacies in the criminal justice system. Therefore the way in which prisoners or forensic patients are supervised after they have been discharged was reformed in 2007 in order to assure a more efficient control of their conduct after their release from custody by means of mandatory treatment and monitoring. Special outpatient clinics were to assist discharged patients in complying with the conditions of probation and parole. However organisational structures for these specialised outpatient institutions vary within Germany because of its federal administration. This results in regional differences in conditions of treatment and probably in differences in quality as well, but surveys about the effects, efficacy or effectiveness of forensic outpatient treatment in Germany are scarce.

Access block and ED overcrowding

Prospective and retrospective access block hospital intervention studies from 1998 to 2008 were reviewed to assess the evidence for interventions around access block and ED overcrowding, including over 220 documents reported in Medline and data extracted from The State of our Public Hospitals Reports. There is an estimated 20-30% increased mortality rate due to access block and ED overcrowding. The main causes are major increases in hospital admissions and ED presentations, with almost no increase in the capacity of hospitals to meet this demand. The rate of available beds in Australia reduced from 2.6 beds per 1000 (1998-1999) to 2.4 beds per 1000 (2002-2007) in 2002, and has remained steady at between 2.5-2.6 beds per 1000. In the same period, the number of ED visits increased over 77% from 3.8 million to 6.74 million. Similarly, the number of public hospital admissions increased at an average rate of 3.4% per year from 3.7 to 4.7 million. Compared with 1998-1999 rates, the number of available beds in 2006-2007 is thus similar (2.65 vs 2.6 beds per 1000), but the number of ED presentations has almost doubled. All patient groups are affected by access block. Access block interventions may temporarily reduce some of the symptoms of access block, but many measures are not sustainable. The root cause of the problem will remain unless hospital capacity is addressed in an integrated approach at both national and state levels.

Milton I. Roemer Advocate of Social Medicine, International Health, and National Health Insurance

Milton I. Roemer Advocate of Social Medicine, International Health, and National Health Insurance

Long stay patients in a psychiatric hospital in Lagos, Nigeria

In the face of recently introduced government health reform and the dwindling number of available beds for acutely ill patients, a cross sectional study was carried out on long-stay patients at the 100 years old psychiatric hospital Yaba, Lagos, Nigeria with a view to discharging most of them. Necessary consent was obtained from the Hospital Research and Ethical Committee. All the long-stay patients were evaluated with a specially designed proforma to elicit socio-demographic, clinical and long-stay variables. Further more, each of them had clinical assessment to make diagnosis in accordance with ICD - 10 and finally, the subjects were also assessed with the Brief Psychiatric Rating Scale (BPRS). Fifty-one (51) subjects; that is, occupying 10.7% of the hospital functional beds fulfilled the criteria of long-stay. They included 36 (70.6%) males and 15(24.4%) females. The mean age was 47.3 inverted exclamation markA16.5 years with age range of 18-92 years. The average length of stay was 11.4 inverted exclamation markA15.0 years and range of 0.5 to 57 years; with significant gender difference (males higher than females) (t =3.51, p<0.02). The vast majority of the subjects were diagnosed with schizophrenia (84.3%), followed by mental retardation with seizure disorder (5.9%). One-third (33.3%) of the subjects had co-morbid physical pathologies most especially epilepsies, hypertension, Koch inverted exclamation mark s disease, HIV/AIDS. Despite being on high doses of antipsychotics (conventional and/or atypical) the majority of the subjects (86.3%) exhibited poor mental state with BPRS scores of inverted exclamation markY10. The mean BPRS score was 23.6 inverted exclamation markA22.0 and range of 4-56 with a significant gender difference (t = 3.66, p< 0.02). These patients would continue to require long-stay hospitalization despite been a burden to the study center; or, in the alternative provision of mid Cway facilities for their rehabilitation.

Violence and Commitment to Treatment: Reply

Back to table of contents Previous article Next article LetterFull AccessLetterE. Fuller Torrey M.D.E. Fuller Torrey M.D.Search for more papers by this authorPublished Online:1 May 2008https://doi.org/10.1176/ps.2008.59.5.576AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Violence and Commitment to Treatment: ReplyIn Reply: Dr. Large and his colleagues make several important points. In their study, individuals undergoing a first episode of psychosis were disproportionately more dangerous. This finding suggests that availability of hospitalization and other treatment is a critical factor if violent behavior is to be reduced. The lack of available psychiatric beds for acutely ill patients in the United States is shocking. The Treatment Advocacy Center recently released a report indicating that this country has only one-third of the public psychiatric beds needed for minimally acceptable care; 51,413 beds exist and 147,233 are needed ( 1 ). In 32 of the 50 states, the psychiatric bed shortage was reported to be critical or severe. Without a sufficient number of available beds, it is impossible to adequately treat individuals undergoing their first episode of psychosis. Reference1. Torrey EF, Entsminger K, Geller J, et al: The Shortage of Public Hospital Beds for Mentally Ill Persons. Arlington, Va, Treatment Advocacy Center, 2008Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 59Issue 5 May, 2008Pages 576-576PSYCHIATRIC SERVICES May 2008 Volume 59 Number 5 Metrics PDF download History Published online 1 May 2008 Published in print 1 May 2008

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterE. Fuller Torrey M.D.E. Fuller Torrey M.D.Search for more papers by this authorPublished Online:1 May 2008https://doi.org/10.1176/ps.2008.59.5.576AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Violence and Commitment to Treatment: ReplyIn Reply: Dr. Large and his colleagues make several important points. In their study, individuals undergoing a first episode of psychosis were disproportionately more dangerous. This finding suggests that availability of hospitalization and other treatment is a critical factor if violent behavior is to be reduced. The lack of available psychiatric beds for acutely ill patients in the United States is shocking. The Treatment Advocacy Center recently released a report indicating that this country has only one-third of the public psychiatric beds needed for minimally acceptable care; 51,413 beds exist and 147,233 are needed ( 1 ). In 32 of the 50 states, the psychiatric bed shortage was reported to be critical or severe. Without a sufficient number of available beds, it is impossible to adequately treat individuals undergoing their first episode of psychosis. Reference1. Torrey EF, Entsminger K, Geller J, et al: The Shortage of Public Hospital Beds for Mentally Ill Persons. Arlington, Va, Treatment Advocacy Center, 2008Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 59Issue 5 May, 2008Pages 576-576PSYCHIATRIC SERVICES May 2008 Volume 59 Number 5 Metrics PDF download History Published online 1 May 2008 Published in print 1 May 2008

Fatores de risco nas lobectomias realizadas para tratar o carcinoma brônquico

Determining which patients will suffercomplications or die when submitted to pulmonaryresection remains the greatest concern ofpulmonologists and thoracic surgeons. Due to theincreasing incidence of lung cancer cases, thefollowing types of pulmonary resection are beingemployed with ever greater frequency:segmentectomy; lobectomy (with or withoutsurgical reconstruction of the bronchus); andpneumonectomy. They can be associated withthoracoplasty, the resection of the superior venacava, aorta or carina.The complexity of the resections depends onchanges in the patterns of patients, who are of anadvanced age, smoke (or used to smoke) heavilyand have one or more of the following comorbidities:varying degrees of emphysema; arterial hypertension;heart disease; diabetes; and vascular diseases(peripheral, renal, hepatic or cerebral).Despite these risks, we cannot counsel againstpulmonary resection, since total resection of thetumor, evaluated in isolation, still offers the bestresults in terms of five-year survival rates. To decreasethese risks, we need to know, with the greatestpossible degree of accuracy, what will occur in theintra-operative and post-operative periods.If we have no notion of what will occur post-operatively, performing a pulmonary resection cancure the cancer and yet, if the resection is tooextensive, leave the patient a pulmonary invalid.In addition, some types of pulmonary resectionsin some patients will certainly create complications,thereby increasing the suffering of the patient, whowill spend more time in the hospital, while reducingthe number of available beds and increasing hospitalcosts. Nor is it acceptable that patients with stageIA lung cancer, whose chances for cure are 80%,suffer complications or die because one or morerisk factors were neglected before surgery, and theappropriate prophylaxis was not performed. In

Current Status of Surge Research

The dramatic escalation of bioterrorism and public health emergencies in the United States in recent years unfortunately has coincided with an equally dramatic decline in the institutions and services we rely on for emergency preparedness. Hospitals in nearly every metropolitan area in the country have closed; those that remain open have reduced the number of available beds. "Just in time" supplies and health professional shortages have further compromised the nation's overall surge capacity. Emergency departments routinely operate at capacity. These circumstances make evidence-based research on emergency preparedness and surge capacity both more urgently needed and more complex. The Agency for Healthcare Research and Quality and other government and private agencies have been rapidly widening the field of knowledge in this area in recent months and years. This report focuses primarily on the work of the Agency for Healthcare Research and Quality.

The burden of paediatric intensive care: a South American perspective

Paediatric intensive care is a relatively new medical specialty that has shown a marked growing up around the world over the last three decades. The limits and the development of this new specialty are not uniform from country to country. Original articles relating to paediatric intensive care and some South American data bases of health care were evaluated and relevant results were selected. Using these data, we describe the main characteristics of paediatric intensive care in South America and discuss some associated factors (e.g. economic aspects, health systems, ethical aspects) that could interfere with the quality and extent of care. A strong relationship between the financial stability of each region and the complexity and quality of paediatric intensive care was seen. A better coverage and more sophisticated paediatric intensive care units (PICUs) are concentrated in the more developed countries (Brazil, Chile and Argentina). Compared to the northern hemisphere, children admitted to the South American PICUs have higher mortality and higher rates of intervention (mechanical ventilation and indwelling catheters). Medical paternalism has a strong influence in the decision-making process offered to terminally ill patients. This phenomenon increases the length of stay, reduces the number of available beds and increases costs. In conclusion, during the last 20 years PICUs have developed and increased their coverage in South America. However, the most sophisticated and well equipped PICUs are preferentially located in the more developed areas whereas those areas with higher infant mortality rates have few PICU beds. Improvements in the economical stability, regional health organisation as well as the rationale for PICU localisation are some of the important goals to be reached in the near future.