Intensive Care use and Organ Failure Interventions Reduced following Changes to the Organisation and Delivery of High Dependency Care

Critical Care Research and Practice

Houwert

et al. 2017

Background. The diversity in formats of Intermediate Care Units (IMCUs) makes it difficult to compare data from different settings. The purpose of this article was to describe and quantify these different formations and utilisation. Methods. We performed a systematic review extracting geographic location, nomenclature used, admitting specialties, open (admitting specialist in charge) or closed (intensivist/generalist in charge) management format, location in hospital, number of beds, nursing workload, medical staff to patient ratios, and modalities—possibilities and limitations—implemented. Results. Nomenclature used was High Dependency Unit (56.8%) or Intermediate Care Unit (24.3%), with the latter one increasingly being used recently. The median number of beds was 6 (IQR 4–10). Location (p < 0.001) and admitting specialties (p = 0.03) were related to the management format. IMCUs integrated or adjacent to Intensive Care Units were more often capable of using single vasoactive medication (p = 0.025). The mean nurse to patient ratio was 1 to 2.5. Conclusions. IMCUs often have a specific task in a hospital, which is reflected in location, format, and utilisation. The management format depends on location and admitting specialist while incorporated supportive treatment modules reflect its function. Common IMCU denominators are continuous monitoring and respiratory support, without mechanical ventilation and multiple vasoactive medications.

“…Seven units were described in more than one article, while two articles described their IMCU before and after changes in management or location structure [19, 20]. …”

Section: Resultsmentioning

confidence: 99%

Utilisation of Intermediate Care Units: A Systematic Review

Critical Care Research and Practice

Houwert

et al. 2017

“…These described the performance of 22 units, since one unit's performance was described by two articles [ 6 , 7 ]. Two studies described their IMCU before and after changes in management or location structure and were therefore each included twice in the quantitative analysis [ 14 , 15 ]. Thus, a total of 24 IMCUs were covered in the quantitative analysis.…”

Section: Resultsmentioning

confidence: 99%

“…All included studies were cohort studies, using either an IMCU cohort ( n = 12) [ 7 , 16 – 26 ] or ICU cohort in presence and absence of the IMCU ( n = 5) [ 11 , 12 , 15 , 27 , 28 ] or using both IMCU and ICU cohorts ( n = 3) [ 29 – 31 ]. Two studies used a hospital cohort to compare the overall in-hospital mortality before and after introduction of the IMCU [ 2 , 22 ].…”

Section: Resultsmentioning

confidence: 99%

“…Two studies used a hospital cohort to compare the overall in-hospital mortality before and after introduction of the IMCU [ 2 , 22 ]. Ten studies were descriptive and noncomparative with respect to the IMCU structure [ 7 , 16 – 18 , 20 , 21 , 23 – 26 ], seven studies performed a before and after introduction comparison including an IMCU (and ICU) cohort [ 2 , 14 , 19 , 22 , 29 – 31 ], and five studies compared their ICU cohorts with and without presence of an IMCU in the hospital [ 11 , 12 , 15 , 27 , 28 ]. An overview of all included studies with their study characteristics is provided in Supplementary file 3 .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A Proposal for an Intermediate Care Unit-Quality Measurement Framework

Peelen

Critical Care Research and Practice

et al. 2018

Rationale, Aims, and Objectives. The Intermediate Care Unit (IMCU) is a hospital unit which is logistically situated between the hospital ward and the Intensive Care Unit (ICU). There is debate regarding the value of the IMCU. Understanding its value is compromised by the lack of adequate quality indicators. Therefore, this study identifies currently used IMCU indicators and evaluates their usefulness. Methods. Through a systematic literature search, currently used quality indicators were identified and evaluated for their importance using a proposed IMCU-specific quality measurement framework. Results. From 4034 titles and abstracts, 168 articles were selected for full-text review. Of these, 22 articles were included, which reported IMCU quality at the level of the IMCU (n = 12), the ICU (n = 5), both IMCU and ICU (n = 3) or hospital level (n = 2). At the IMCU, the IMCU mortality (n = 16), discharge-to-ICU rate (n = 7), in-hospital IMCU mortality (n = 7), and length of stay (n = 6) were most frequently reported. Three studies compared the effect of different structures of the IMCU on its utilization or hospital outcome. Conclusions. Current focus in IMCU quality research is towards measuring quality at the IMCU itself. Since the influence of the structure of IMCUs on its utilization and its effects on hospital outcome are only rarely investigated, attention should shift towards these important issues in further research. The proposed IMCU quality measurement framework can thereby serve as a helpful tool.

“…The choice of management format has been a subject of debate in the ICU literature, 4–7 but for the IMCU only few studies have been performed. 8–10 However, these studies focused on the effects of IMCU management formats on the utilization of the ICU, 9 did not compare different management formats, 10 or compared formats along with a physical relocation of the unit. 8 …”

Section: Introductionmentioning

confidence: 99%

Joint management format at the mixed-surgical intermediate care unit: an interrupted time series analysis

Peelen

Trauma Surg Acute Care Open

et al. 2018

BackgroundThe management format of the mixed-surgical intermediate care unit (IMCU) affects its performance. A format of combined supervision of surgeons with additional critical care certifications and admitting specialists, named the “joint format”, may herein be a promising new model of specialized critical care. This study aims to assess the performance of the joint management format.MethodsThis observational cohort study compared three IMCU management formats at the stand-alone, mixed-surgical IMCU of a tertiary referral hospital using interrupted time series analyses. All admissions from 2001 until 2015 were included. Predetermined criteria for performance (utilization, efficiency, and safety) were applied to three different management format periods: open (2001–2006), closed (2006–2011), and joint (2011–2015) formats.ResultsA total of 8894 admissions were analyzed. In terms of case load (utilization), there was an overall increase in the number of surgical patients (0.25%/year) (p<0.001), age (0.38/year) (p<0.001), and readmissions from the ward (0.16%/year) (p<0.001) and from the intensive care unit (ICU) (0.17%/year) (p=0.014). In terms of efficiency, the admission duration decreased (1.58 hours/year) (p<0.001). Transfer to the ICU within 24 hours, readmission within 24 hours from the ward, and unplanned mortality (eg, safety) did not change over time.DiscussionAt a time of increasingly complex case load, the joint format at the mixed-surgical IMCU is an efficient and safe management format in which the admitting specialist continues to provide specialized care. Specialty-specific supervision at IMCUs is a safe option which should be considered in healthcare policy decisions.Level of evidenceLevel IV.