Introducing an integrated intermediate care unit improves ICU utilization: a prospective intervention study

Abstract

BackgroundImprovement of appropriate bed use and access to intensive care (ICU) beds is essential in optimizing utilization of ICU capacity. The introduction of an intermediate care unit (IMC) integrated in the ICU care may improve this utilization.MethodIn a before-after prospective intervention study in a university hospital mixed ICU, the impact of introducing a six-bed mixed IMC unit supervised and staffed by ICU physicians was investigated. Changes in ICU utilization (length of stay, frequency of mechanical ventilation use), nursing workload assessed byTISS-28 score, as well as inappropriate bed use, accessibility of the ICU (number of referrals), and clinical outcome indicators (readmission and mortality rates) were measured.ResultsDuring 17 months, data of 1027 ICU patients were collected. ICU utilization improved significantly with an increased appropriate use of ICU beds. However, the number of referrals, readmissions to the ICU and mortality rates did not decrease after the IMC was opened.ConclusionThe IMC contributed to a more appropriate use of ICU facilities and did result in a significant increase in mean nursing workload at the ICU.

Medical surveillance unit: patient characteristics, outcome, and quality of care in Saskatchewan, Canada

“…The introduction of an IMCU contributed to a more appropriate use of ICU facilities and did result in a significant increase in mean nursing workload at the ICU [13]. Lu et al found that the average length of stay in the IMCU was 4.23-7.24 days, which is similar to our average of 5.31 ± 5.04 days (data not shown) [11].…”

Characteristics and outcomes of patients admitted to Spanish ICU: A prospective observational study from the ENVIN-HELICS registry (2006–2011)

“…Life Support Withholding and Withdrawing policies were not considered, as well as the discharge to Intermediate Care Units, which may have affected both the percentage of patients who died and the length of stay in the ICU. 35 Although mean APACHE II scores were annually assessed, we assumed that other factors that may influence upon mortality in critically ill patients, 36 such as the number of patients with malignancies or septic complications (septic shock or adult respiratory distress syndrome) did not vary during the study period, although this aspect was not examined. It is also assumed that during the 6-year study period, important changes in the overall care of critically ill patients did not occur, although mortality in some particular groups of patients may have decreased as a consequence of changes in clinical practice.…”

Characteristics of Short‐stay Critical Care Admissions From Emergency Departments in Maryland

“…Thus, while approximately two‐thirds of critical care admissions required at least 1 additional day of hospital care, a substantial proportion did not appear to require substantively longer additional hospital care after discharge from a critical care unit. Admissions based on specified conditions with a high likelihood of short‐stay critical care could potentially be suitable for the hospital floor or alternate care locations such as a postanesthesia care unit or an ED‐based critical care unit . These options have the potential to reduce the pressures on inpatient critical care units to discharge or transfer patients quickly.…”