Method, apparatus and medium for allocating beds in a pediatric intensive care unit and for evaluating quality of care

• US 5,809,477 A
• Filed: 09/21/1995
• Issued: 09/15/1998
• Est. Priority Date: 09/21/1995
• Status: Expired due to Term

• Current Assignee: Childrens Hospital Los Angeles
• Original Assignee: Children's Research Institute
• Inventors: Pollack, Murray M.
• Primary Examiner(s): Hudspeth, David R.
• Assistant Examiner(s): Thomas, Joseph
• Application Number:
  US08/531,695
• Time in Patent Office: 1,090 Days
• Field of Search: 395/202, 395/203, 395/205, 395/206, 395/207, 395/208, 395/209, 705/235, 705/6, 705/7, 705/8, 705/9
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/02 Reservations, e.g. for tickets, services or events
• CPC Class Codes: G06Q 10/025 Coordination of plural reservations, e.g. plural trip segments, transportation combined with accommodation
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 10/06395 Quality analysis or management
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

Computer implemented processes are disclosed for quantifying the severity of condition of patients of a pediatric hospital or pediatric intensive care unit. The measure of severity of condition can be used to calculate a probability of death during hospitalization as well as the expected length of stay for a patient, given information gathered about the patient during the initial hours of hospitalization. This information may then be used to determine availability of beds and to provide objective measures of the quality of care provided by a pediatric hospital or part thereof.

Claims

1. A computer implemented method for allocating beds for a pediatric hospital comprising:

a. obtaining patient information for each patient admitted to the hospital, and determining a score, PRISM III-24, for the patient;

b. calculating an estimated duration, LOS, for the hospital stay of said each patient based on said score as follows;

space="preserve" listing-type="equation">LOS=(b.sub.PRISM III 24 +d.sub.0 +d.sub.1 x.sub.1 + . . . +d.sub.p x.sub.p)

where b_PRISM III 24 =coefficients from PRISM III-24 ranges as follows;

space="preserve" listing-type="tabular">______________________________________ PRISM III-24 b.sub.PRISM III 24 ______________________________________ 0-13 0.05823 + 0.530 (PRISM III-24) 14-16 1.2725 17-23 3.3365 - 0.1214 (PRISM III-24) 24-27 0.5442 28-34 0.3564 >

34 0 ______________________________________

where d₀ =0.4167,

and where d_i are the coefficients for the following diagnostic groups and x_i =1 if the condition is present and x_i =0 if the condition is not present, the diagnostic groups and their coefficients being;

space="preserve" listing-type="tabular">______________________________________ Diagnosis d.sub.i ______________________________________ Oncologic disease +0.1529 Pneumonia (viral or bacterial) +0.4291 Central Nervous System infections +0.3973 Drug overdose -0.1973 ICU admission for treatment of acute -0.2528 diabetes or its complications ICU admission for treatment of congenital +0.1749 heart disease (non-operative) Postoperative +0.1529 Admission from inpatient area (excluding +0.2554 operating or recovery room Previous ICU admission during the current +0.1754 hospitalization Use of mechanical ventiliation during the +0.5102 first 24 hours ______________________________________

c. determining the number of hospital beds in use at a point in time using the dates of admission and LOS determined for each patient admitted to said hospital, and

d. allocating hospital beds to patients awaiting admission based on said number of hospital beds in use.

2. A computer readable storage medium containing a program implementing the method of claim 1.

3. A computer implemented method for determining the probable length of stay of a patient in a pediatric intensive care unit, comprising:

a. recording patient information for said patient and determining a score, PRISM III-24, for the patient;

b. calculating probable length of stay, LOS, for said patient based on said score as follows;

space="preserve" listing-type="equation">LOS=(b.sub.PRISM III 24 +d.sub.0 +d.sub.1 x.sub.1 + . . . +d.sub.p x.sub.p)

where b_PRISM III 24 =coefficients from PRISM III-24 ranges as follows;

space="preserve" listing-type="tabular">______________________________________ PRISM III-24 b.sub.PRISM III 24 ______________________________________ 0-13 0.05823 + 0.530 (PRISM III-24) 14-16 1.2725 17-23 3.3365 - 0.1214 (PRISM III-24) 24-27 0.5442 28-34 0.3564 >

34 0 ______________________________________

where d₀ =0.4167,

and where d_i are the coefficients for the following diagnostic groups and x_i =1 if the condition is present and x_i =0 if the condition is not present, the diagnostic groups and their coefficients being;

space="preserve" listing-type="tabular">______________________________________ Diagnosis d.sub.i ______________________________________ Oncologic disease +0.1529 Pneumonia (viral or bacterial) +0.4291 Central Nervous System infections +0.3973 Drug overdose -0.1973 ICU admission for treatment of acute -0.2528 diabetes or its complications ICU admission for treatment of congenital +0.1749 heart disease (non-operative) Postoperative +0.1529 Admission from inpatient area (excluding +0.2554 operating or recovery room Previous ICU admission during the current +0.1754 hospitalization Use of mechanical ventiliation during the +0.5102 first 24 hours ______________________________________

c. allocating intensive care unit resources based on calculated probable length of stay.

4. A computer readable storage medium containing a program implementing the method of claim 3.

11. A computer implemented method for evaluating the quality of care of a pediatric hospital, comprising:

for a group of patients in the hospital during a period of interest, determining a probability of death for each patient in said group in accordance with claim 4, and further comprising the steps of;

e. using the set of probabilities of death for each patient in said group, determining an expected number of deaths for said group;

f. for said group of patients, determining the actual number of deaths, and

g. determining a measure of quality using the expected number of deaths and the actual number of deaths.

5. A computer implemented method of objectively rating the severity of a patient'"'"'s condition comprising:

a. obtaining patient information for a patient;

b. determining a numerical value for each of the following categories of information for the patient by assigning the value indicated by the range in which the patient'"'"'s information falls or otherwise assigning

space="preserve" listing-type="tabular">______________________________________ Cardiovascular/NeurologicVital Signs 1. Systolic blood pressure (mm Hg) Age Value = 3 Value = 7 Neonate 40-55 <

40 Infant 45-65 <

45 Child 55-75 <

55 Adolescent 65-85 <

65 2. Temperature (degrees Centrigrade) All ages <

33 or >

40.0 Value = 3 3. Mental Status All ages Stupor/Coma (GCS <

8) Value = 5 4. Heart Rate (beats per minute) Age Value = 3 Value = 7 Neonate 215-255 <

225 Infant 215-225 <

225 Child 185-205 <

205 Adolescent 145-155 <

155 5. Pupillary Reflexes All Ages One fixed, one reactive Value = 7 All Ages Both fixed Value = 11 Acid-Base/Blood Gases 1. Acidosis (Total CO.sub.2 (mmol/L) or pH) All Ages pH 7.0-7.28 or total CO.sub.2 5-16.9 Value = 2 All Ages pH <

7.0 or total CO.sub.2 <

5 Value = 6 2. pH All Ages 7.48-7.55 Value = 2 All Ages >

7.55 Value = 3 3. PCO.sub.2 (mm Hg) All Ages 50.0-75.0 Value = 1 All Ages >

75.0 Value = 3 4. Total CO.sub.2 (mmol/L) All Ages .34.0 Value = 4 5. PaO.sub.2 (mm Hg) All Ages 42.0-49.9 Value = 3 All Ages >

42.0 Value = 6 Chemistry Tests 1. Glucose All Ages >

200 mg/dL or >

11.0 mmol/L Value = 2 2. Creatinine Value = 2 Neonate >

0.85 mg/dL or >

75 μ

mol/L Infant >

0.90 mg/dL or >

80 μ

mol/L Child >

0.90 mg/dL or >

80 μ

mol/L Adolescent >

1.30 mg/dL or >

115 μ

mol/L 3. Potassium (mmol/L) All Ages >

6.9 Value = 3 4. Blood Urea Nitrogen (BUN) Value = 3 Neonate >

11.9 or >

4.3 mmol/L All Other Ages >

14.9 or >

5.4 mmol/L Hematology Tests 1. White Blood Cell Count (cells/mm.sup.3) All ages <

3,000 Value = 4 2. Platelet Count (cells/mm.sup.3) All Ages 100,000-200,000 Value = 2 All Ages 50,000-99,999 Value = 4 All Ages <

50,000 Value = 5 3. Prothrombin Time (PT) or Partial Thromboplastin Time (PTT) seconds) Value = 3 Neonate PT >

22.0 or PTT >

85.0 All Other Ages PT >

22.0 or PTT >

57.0 ______________________________________

c. summing all values to produce an overall score, PRISM III, which is an objective rating of the severity of the patient'"'"'s condition, and

d. allocating resources to a patient based on the overall score.

6. A computer readable storage medium containing a program implementing the method of claim 5.

7. The computer method of objectively rating the severity of a patient'"'"'s condition as set forth in claim 5, further comprising:

calculating a probability of death of the patient during the patient'"'"'s admission to a pediatric intensive care unit as follows;

P(death)=1/(1+e^-R), where R is a function of PRISM III information gathered over the first 12 hours of a patient'"'"'s admission to the hospital and ln is the natural logarithm.

8. The computer method of claim 7 in which:

R=-5.2560+0.2759(PRISM III-12).

9. The method of claim 7 in which:

R=-5.5434+0.3441(PRISM III-12)-0.00267(PRISM III-12)², where (PRISM III-12)² is the PRISM III-12 term squared.

10. The computer method of claim 7 in which:

R=-5.8294+0.3318(PRISM III-12)-0.00265(PRISM III-12)² +0.4899(Pre-ICU care area)-0.6619(operative status)+0.6620(previous ICU admission)-1.7463(acute diagnosis of diabetes)+0.5148(chromosomal anomaly)+0.7634(acute or chronic oncologic disease)+0.6737(acute nonoperative cardiovascular disease)+1.1103(pre-ICU cardiac massage), where

pre-ICU care area=1 if the admission is from an inpatient location, excluding the operating room or recovery room;

otherwise it=0;

where operative status=1 if postoperative admission;

otherwise it=0;

where previous ICU admission=1 if there was a previous ICU admission during current hospitalization;

otherwise it=0;

where acute diagnosis of diabetes=1 if acute problem requiring ICU admission is associated with diabetes (such as ketoacidosis);

otherwise it=0;

where chromosomal anomaly=1 if there is a chromosomal anomaly such as extra chromosome, a long or short arm deletion, or a long or short arm addition;

otherwise it=0;

where acute or chronic oncologic disease=1 if there is currently or has been a malignant oncologic disease (cancer);

otherwise it=0;

where Acute nonoperative cardiovascular disease=1 if the acute problem requiring ICU admission is associated with congenital or acquired cardiac or vascular disease, excluding postoperative care;

otherwise it=0; and

where Pre-ICU cardiac massage=1 if there has been closed or open chest cardiac massage (cardiac compressions) immediately prior to the PICU admission;

otherwise it=0.

12. The computer method of objectively rating the severity of a patient'"'"'s condition as set forth in claim 7, further comprising:

calculating a probability of death of the patient during the patient'"'"'s admission to a pediatric intensive care unit as follows;

P(death)=1/(1+e^-R), where R is a function of PRISM III information gathered over the first 24 hours of a patient'"'"'s admission to the hospital.

13. The computer method of claim 12 in which:

R=-5.5743+0.2652(PRISM III-24).

14. The computer method of claim 12 in which:

R=-6.0396+0.3544(PRISM III-24)-0.00304(PRISM III-24)², where (PRISM III-12)² is the PRISM III-12 term squared.

15. The computer method of claim 12 in which:

R=-6.2833+0.3377(PRISM III-24)-0.00283(PRISM III-24)² +0.4536(Pre-ICU care area)-0.6966(operative status)+0.6650(previous ICU admission)-1.6763(acute diagnosis of diabetes)+0.5568(chromosomal anomaly)+0.7746(acute or chronic oncologic disease)+0.6467(acute nonoperative cardiovascular disease)+1.1197(pre-ICU cardiac massage) where

pre-ICU care area=1 if the admission is from an inpatient location, excluding the operating room or recovery room;

otherwise it=0;

where operative status=1 if postoperative admission;

otherwise it=0;

where previous ICU admission=1 if there was a previous ICU admission during current hospitalization;

otherwise it=0;

where acute diagnosis of diabetes=1 if acute problem requiring ICU admission is associated with diabetes (such as ketoacidosis);

otherwise it=0;

where chromosomal anomaly=1 if there is a chromosomal anomaly such as extra chromosome, a long or short arm deletion, or a long or short arm addition;

otherwise it=0;

where acute or chronic oncologic disease=1 if there is currently or has been a malignant oncologic disease (cancer);

otherwise it=0;

where Acute nonoperative cardiovascular disease=1 if the acute problem requiring ICU admission is associated with congenital or acquired cardiac or vascular disease, excluding postoperative care;

motherwise it=0; and

where Pre-ICU cardiac massage=1 if there has been closed or open chest cardiac massage (cardiac compressions) immediately prior to the PICU admission;

otherwise it=0.

16. A computer readable storage medium containing a program implementing the method of claim 12.

17. A computer implemented method of objectively rating the severity of a patient'"'"'s condition comprising:

a. obtaining patient information for a patient based on the first 24 hours after admission;

b. determining a numerical value for each of the following categories of information for the patient by assigning the value indicated by the range in which the patient'"'"'s information falls or otherwise assigning 0;

space="preserve" listing-type="tabular">______________________________________ Age Range Score Range Score ______________________________________ Respiratory Rate (HIGH) N >

100 8 I >

100 8 C >

80 8 A >

60 8 Blood Pressure - Systolic (LOW) N <

40 19 40-50 4 I <

45 19 45-55 4 C <

55 19 55-65 4 A <

65 19 65-75 4 N 51-55 2 I 56-65 2 C 66-75 2 A 76-85 2 Blood Pressure - Diastolic (HIGH) N >

80 4 I >

95 4 C >

100 4 A >

110 4 Heart Rate (LOW) N >

75 6 I >

75 6 C >

55 6 A >

55 6 Heart Rate (HIGH) N 195-214 3 215-225 5 I 195-214 3 215-225 5 C 165-184 3 185-205 5 A 135-144 3 145-155 5 N 225<

9 I 225<

9 C 205<

9 A 155<

9 Creatinine (HIGH) N 0.70-0.85 1 0.85<

4 I 0.75-0.90 1 0.90<

4 C 0.75-0.90 1 0.90<

4 A 1.00-1.30 1 1.30<

4 BUN (HIGH) N 12-15 5 15<

10 I 15-20 5 20<

10 C 15-20 5 20<

10 A 15-20 5 20<

10 HCO.sub.3 or Total CO.sub.2 (LOW) All Ages 17-20 1 <

17-14 2 All Ages <

14-8 5 <

8-5 6 All Ages <

5 7 pH (LOW) All Ages 7.2-7.28 2 <

7.2-7.1 3 All Ages <

7.1-7.0 7 <

7.0 11 pH (HIGH) All Ages 7.48-7.55 4 <

7.55-7.6 7 All Ages <

7.6 12 PCO.sub.2 (HIGH) All Ages 50-60 4 <

60-75 7 All Ages <

75 12 PCO.sub.2 (LOW) All Ages 50-60 5 <

50-42 7 All Ages <

42 11 Hemoglobin (HIGH) All Ages >

14 3 Platelet (LOW) All Ages 1000-200 2 <

100-50 7 All Ages <

50 11 WBC (LOW) All Ages 4.5-6.0 2 <

4.5-3.0 4 All Ages <

3.0 11 PT (HIGH) All Ages 16.5-22 3 <

22 6 PTT (HIGH) All Ages 16.5-22 3 <

22 6 Calcium (Ca, HIGH) All Ages 10.5-12.0 6 <

12.0 7 Glucose (LOW) All Ages <

60-50 1 <

50-40 5 All Ages <

40-30 6 <

30 8 Glucose (HIGH) All Ages 160-200 1 >

200-250 1 All Ages >

250-400 2 >

400 3 Sodium (Na, HIGH) All Ages 146-150 1 >

150 3 Temperature (rectal, oral, blood, axillary) (LOW) All Ages <

33 11 Temperature (rectal, oral, blood, axillary) (HIGH) All Ages >

40 9 Pupils, size and reactivity (WORST) All Ages both fixed 31 one fixed 1 Coma (WORST) All Ages stupor/coma 13 ______________________________________

where N=neonate (0-<

1 month);

I=infant (1-<

12 months);

C=child (12-<

=144 months);

A=adolescent (>

144 months);

c. summing all values to produce an overall score, PRISM III-APS, which is an objective rating of severity of the patient'"'"'s condition; and

d. allocating resources to a patient based on the severity of the patient'"'"'s condition.

18. A computer readable storage medium containing a program implementing the method of claim 17.

19. The computer method of objectively rating the severity of a patient'"'"'s condition as set forth in claim 17, further comprising:

calculating a probability of death of the patient during the patient'"'"'s admission to a pediatric intensive care unit as follows;

P(death)=1/(1+e^-R), where R is a function of PRISM III-APS information gathered over the first 24 hours of a patient'"'"'s admission to the hospital and ln is the natural logarithm.

20. The computer method of claim 19 in which:

R=-5.4935+0.1016(PRISM III-APS).

21. The computer method of claim 19 in which:

R=-6.0176+0.1410(PRISM III-APS)-0.00051(PRISM III-APS)², where (PRISM III-APS)² is the PRISM III-APS term squared.

22. The computer method of claim 19 in which:

R=-7.0928+0.0706(PRISM III-APS)+0.8080 ln(PRISM III-APS+1)!, where ln is the natural logarithm.

23. The computer method of claim 19 in which:

R=7.3309+0.0700(PRISM III-APS)+0.7301 ln(PRISM III-APS+1)!+0.5216(previous ICU care area)-0.5399(operative status)+0.5921(previous ICU admission)-1.9775(acute diagnosis of diabetes)+0.5572(chromosomal anomaly)+0.8360(acute or chronic oncologic disease)+0.8266(acute nonoperative cardiovascular disease)+1.0715(pre-ICU cardiac massage), where

pre-ICU care area=1 if the admission is from an inpatient location, excluding the operating room or recovery room;

otherwise it=0;

where operative status=1 if postoperative admission;

otherwise it=0;

where previous ICU admission=1 if there was a previous ICU admission during current hospitalization;

otherwise it=0;

where acute diagnosis of diabetes=1 if acute problem requiring ICU admission is associated with diabetes (such as ketoacidosis);

otherwise it=0;

where chromosomal anomaly=1 if there is a chromosomal anomaly such as extra chromosome, a long or short arm deletion, or a long or short arm addition;

otherwise it=0;

where acute or chronic oncologic disease=1 if there is currently or has been a malignant oncologic disease (cancer);

otherwise it=0;

where Acute nonoperative cardiovascular disease=1 if the acute problem requiring ICU admission is associated with congenital or acquired cardiac or vascular disease, excluding postoperative care;

otherwise it=0; and

where Pre-ICU cardiac massage=1 if there has been closed or open chest cardiac massage (cardiac compressions) immediately prior to the PICU admission;

otherwise it=0.

24. A computer implemented method of objectively rating the severity of a patient'"'"'s condition comprising:

a. obtaining patient information for a patient;

b. determining a numerical value for each of the following categories of information for the patient by assigning the value indicated by the range in which the patient'"'"'s information falls or otherwise assigning 0;

space="preserve" listing-type="tabular">______________________________________ Age Restrictions and Variable Ranges Score ______________________________________ Systolic BP (mm Hg) Infants Children 130-160 150-200 2 55-65 65-75 >

160 >

200 6 40-54 50-64 <

40 <

50 7 Diastolic BP (mm Hg) all ages 6 >

110 HR (beat/min) Infants Children >

160 >

150 4 Respiratory rate Infants Children (breath/min) 61-90 51-70 1 >

90 >

70 5 Apnea Apnea PaO.sub.2 /F10.sub.2 .sup. a! all ages 200-300 2 <

200 3 Paco! PaCo.sub.2 .sup. b! (torr) all ages 51-65 1 >

65 5 Glasgow Coma Score .sup.c ! all ages >

8 6 Pupillary Reactions all ages unequal or dilated 4 fixed and dilated 10 PT/PTT all ages 1.5 ×

control 2 Total bilirubin (mg/dl) >

1 mo >

3.5 6 Potassium (mEq/L) all ages 3.0-3.5 1 6.5-7.5 <

3.0 5 >

7.5 Calcium (mg/dl) all ages 7.0-8.0 2 12.0-15.0 <

7.0 6 >

15.0 Glucose (mg/dl) all ages 40-60 4 250-400 <

40 8 >

400 Bicarbonate .sup.d ! (MEq/L) all ages <

16 3 >

32 ______________________________________

c. summing all values to produce an overall score, PRISM,

d. determining the severity of the patient'"'"'s condition, by calculating a probability of death of the patient during the patient'"'"'s admission to a pediatric intensive care unit as follows;

P(death)=1/(1+e^-R), where R is a function of PRISM information gathered over the first 24 hours of a patient'"'"'s admission to the hospital and ln is the natural logarithm and

R=-6.6129+0.2864(PRISM)-0.00162(PRISM)² -0.7482(operative status)+1.1659(chromosomal anomaly)+1.0794(acute or chronic oncologic disease)+0.6620(pre-ICU care area)+1.3707(pre-ICU cardiac massage),

where (PRISM)² is the PRISM term squared,

where operative status=1 if postoperative admission;

otherwise it=0

where chromosomal anomaly=1 if there is a chromosomal anomaly such as extra chromosome, a long or short arm deletion, or a long or short arm addition;

otherwise it=0;

where acute or chronic oncologic disease=1 if there is currently or has been a malignant oncologic disease (cancer);

otherwise it=0;

where pre-ICU care area=1 if the admission is from an inpatient location, excluding the operating room or recovery room;

otherwise it=0; and

where pre-ICU cardiac massage=1 if there has been closed or open chest cardiac massage (cardiac compressions) immediately prior to the PICU admission;

otherwise it=0, and

e. allocating resources to a patient based on the severity of the patient'"'"'s condition.

25. A computer readable storage medium containing a program implementing the method of claim 24.

26. A computer implemented method of objectively rating the severity of a patient'"'"'s condition comprising:

a. obtaining patient information for a patient;

b. determining a numerical value for each of the following categories of information for the patient by assigning the value indicated by the range in which the patient'"'"'s information falls or otherwise assigning 0;

space="preserve" listing-type="tabular">______________________________________ Age Restrictions and Variable Ranges Score ______________________________________ Systolic BP (mm Hg) Infants Children 130-160 150-200 2 55-65 65-75 >

160 >

200 6 40-54 50-64 <

40 <

50 7 Diastolic BP (mm Hg) all ages 6 >

110 HR (beat/min) Infants Children >

160 >

150 4 Respiratory rate Infants Children (breath/min) 61-90 51-70 1 >

90 >

70 5 Apnea Apnea PaO.sub.2 /F10.sub.2 all ages 200-300 2 <

200 3 Paco.sub.2 ! PaCo.sub.2 (torr) all ages 51-65 1 >

65 5 Glasgow Coma Score .sup.c ! all ages >

8 6 Pupillary Reactions all ages unequal or dilated 4 fixed and dilated 10 PT/PTT all ages 1.5 ×

control 2 Total bilirubin (mg/dl) >

1 mo >

3.5 6 Potassium (mEq/L) all ages 3.0-3.5 1 6.5-7.5 <

3.0 5 >

7.5 Calcium (mg/dl) all ages 7.0-8.0 2 12.0-15.0 <

7.0 6 >

15.0 Glucose (mg/dl) all ages 40-60 4 250-400 <

40 8 >

400 Bicarbcnate .sup.d ! (MEq/L) all ages <

16 3 >

32 ______________________________________

c. summing all values to produce an overall score, PRISM,

d. determining the severity of the patient'"'"'s condition, by calculating a probability of death of the patient during the patient'"'"'s admission to a pediatric intensive care unit as follows;

P(death)=1/(1+e^-R), where R is a function of PRISM information gathered over the first 24 hours of a patient'"'"'s admission to the hospital and ln is the natural logarithm and

R=-7.0086+0.2312(PRISM)-0.00102(PRISM)² -0.9098(operative status)+0.6751(chromosomal anomaly)+0.9064(acute or chronic oncologic disease)+0.9580(pre-ICU care area)-1.3455(pre-ICU cardiac massage)

where (PRISM)² is the PRISM term squared,

where operative status=1 if postoperative admission;

otherwise it=0

where chromosomal anomaly=1 if there is a chromosomal anomaly such as extra chromosome, a long or short arm deletion, or a long or short arm addition;

otherwise it=0;

where acute or chronic oncologic disease=1 if there is currently or has been a malignant oncologic disease (cancer);

otherwise it=0;

where pre-ICU care area=1 if the admission is from an inpatient location, excluding the operating room or recovery room;

otherwise it=0; and

where pre-ICU cardiac massage=1 if there has been closed or open chest cardiac massage (cardiac compressions) immediately prior to the PICU admission;

otherwise it=0, and

e. allocating resources to a patient based on the severity of the patient'"'"'s condition.

27. A computer readable storage medium containing a program implementing the method of claim 26.