Point Prevalence of Parental Presence in the Pediatric Intensive Care Unit (5Ps)

Introduction: Family-centered care is the standard of care in pediatric intensive care units (PICUs), offering benefits to caregivers, patients, and the medical team. However, families are present at bedside for differing amounts of time, and factors affecting time at bedside are understudied. Prior studies investigating this using parental surveys are hampered by recall or social desirability bias. Therefore, we performed a point prevalence study quantifying time at bedside using direct observation. We hypothesized that race, ethnicity, insurance type, zip-code based social deprivation index (SDI), and preferred language were associated with differential caregiver time at bedside in the PICU.


Methods: We performed a single-center (75-bed PICU), prospective point prevalence study in 14 separate 48-hour periods between August 2022 and June 2023. Eligible subjects had > 2 and < 120 PICU days at time of screening and anticipated additional length of PICU stay > 2 days. Bedside nurses continuously documented caregiver presence for each 48-hour epoch. We then performed quantile regression to examine the association between caregiver time at bedside and race, ethnicity, insurance type, SDI, and preferred language, controlling for pre-selected confounders. We projected a sample size of 150 subjects to detect a 20% difference (~10 hours over 48 hours) with 80% power.


Results: In 158 subjects, median time at bedside was 39 hours (IQR 8, 48) over the 48-hour period with a bimodal distribution (peaks at 0-4 and 44-48 hours). After adjustment for confounders, Black race was associated with a median 17 fewer hours of caregiver time at the bedside over the 48-hour period (relative to White race), and public insurance was associated with a median 15 fewer hours (relative to private insurance). Ethnicity, SDI, and preferred language were not associated with time at bedside.


Conclusions: In a point prevalence study using direct observation of caregiver presence, race and insurance status affected the amount of time caregivers spent at bedside in the PICU. These differences may be driven by unknown, but potentially addressable, barriers. Further studies are necessary to explore factors underlying these disparities and evaluate the impact of family presence on outcomes.