• Andrew C Argent, Johann Ahrens, Brenda M Morrow, Louis G Reynolds, Mark Hatherill, Shamiel Salie, and Solomon R Benatar.
• 1Paediatric Intensive Care Unit, Red Cross War Memorial Children's Hospital, Cape Town, South Africa. 2Division of Paediatric Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. 3Education Development Unit, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. 4Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. 5Bioethics Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
• Pediatr Crit Care Me. 2014 Jan 1;15(1):7-14.

ObjectiveTo develop explicit criteria for patient admission in order to optimize utilization of PICU facilities in the face of increasing demand outstripping resources.SettingMultidisciplinary PICU in a university-affiliated referral hospital in Cape Town, South Africa.DesignRetrospective description of policy development and implementationPatientsAll patients referred to the Paediatric Intensive Care Unit of the Red Cross War Memorial Children's Hospital.InterventionsDevelopment and application of admission policy.Measurements And Main ResultsIn consultation with clinicians at the hospital, principles for utilization of PICU resources were established and then translated into specific policies for prioritization of admission of particular groups of patients. The hospital team developed and implemented: criteria for intensive care admission; prioritization for certain categories of patients (including those scheduled for elective surgery); processes for refusing intensive care admission to other categories of patients; and processes to review implementation. These criteria and procedures were made explicit to clinicians, administrators, and managers and eventually agreed to by them. It was challenging to obtain "buy-in" from all potential stakeholders in the process and also to implement such policies under conditions of high stress.ConclusionDevelopment and implementation of explicit policies for utilization of PICU resources provide a "reasonable" process for fair and equitable utilization of scarce resources. The factors that have to be considered while developing these policies may extend beyond the priorities of individual patients. Implementation is still fraught with problems. Development of explicit admission policies that consider the needs of individual patients and also the longer term development of healthcare services may enable the retention of small but essential services.

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