Results of a retrospective observational study of intermediate care staffed by hospitalists: Impact on mortality, co‐management, and teaching

Lucena, Juan Felipe; Alegre, Félix; Rodil, Raquel; Landecho, Manuel F.; García-Mouriz, Alberto; Marqués, María; Aquerreta, Irene; Garcı́a, Nicolás; Quiroga, Jorge

doi:10.1002/jhm.1905

Cited by 20 publications

(22 citation statements)

References 26 publications

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“…Multiple studies support the assertion that IMCUs reduce cost without negatively affecting outcomes. 1,10,12,18,19 Although no definitive study exists in either adult or pediatric medical literature, results from our study support that IMCUs identified in this study care for patients who would often be triaged to an ICU at institutions with no IMCU. True cost implications of this variation in triage would require further study.…”

Section: Discussionsupporting

confidence: 62%

“…This is in keeping with data from adult literature that support the role of the IMCU in improving ICU utilization for sicker patients. [9][10][11][12] In particular, Byrick et al 13,14 described the impact of closure of an IMCU in 1 hospital, resulting in a fourfold increase in ICU admissions with a lower severity of illness. More recent literature describes successful care for adult patients with specific diseases in IMCUs, including severe asthma and sepsis.…”

Section: Discussionmentioning

confidence: 99%

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Triage of Intermediate-Care Patients in Pediatric Hospitals

Russ

Agus

2015

Hospital Pediatrics

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BACKGROUND: Hospitalized children have a wide range of acuity and risk of decompensation. The objective of this study was to determine where pediatric patients are triaged when they present to pediatric hospitals needing intense monitoring and nursing care, but do not require invasive monitoring or technology. METHODS: We completed a telephone survey of pediatric hospitals in the United States with at least 2 non-neonatal pediatric wards and at least 50 acute inpatient beds. The survey consisted of a brief scripted portrayal of 6 hypothetical patients who may be admitted to a hospital's general floor, ICU, or an intermediate care unit (IMCU). The scenarios included severe asthma, bronchiolitis, croup, diabetic ketoacidosis, and patients dependent on home ventilation via noninvasive interface or tracheostomy. The hospital bed coordinator or emergency department charge nurse was asked where each hypothetical patient would be admitted in their hospital. RESULTS: A total192 hospitals met inclusion criteria and 164 hospitals (85%) responded. For all of the scenarios, most of the institutions triaged them to the PICU. Twenty-eight (17%) of the responding institutions triaged at least 1 of the patient scenarios to an IMCU. The presence of an IMCU decreased triage to the ICU for all scenarios when comparing hospitals with and without an IMCU (P < .001). CONCLUSIONS: Inpatient triage practices among pediatric hospitals vary widely for patients who require intense nursing or frequent monitoring due to specific acute illnesses or respiratory technologies. Institutions that have an IMCU available are less likely to send these patients to the ICU.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Triage of Intermediate-Care Patients in Pediatric Hospitals

Russ

Agus

2015

Hospital Pediatrics

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“…Although intermediate care is worldwide recognized, there are few studies in the last decades demonstrating the efficacy of these areas [3-12]. Moreover, there are only two previous descriptions of SAPS II in this setting [11,12].…”

Section: Discussionmentioning

confidence: 99%

Performance of SAPS II and SAPS 3 in Intermediate Care

et al. 2013

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ObjectiveThe efficacy and reliability of prognostic scores has been described extensively for intensive care, but their role for predicting mortality in intermediate care patients is uncertain. To provide more information in this field, we have analyzed the performance of the Simplified Acute Physiology Score (SAPS) II and SAPS 3 in a single center intermediate care unit (ImCU).Materials and MethodsCohort study with prospectively collected data from all patients admitted to a single center ImCU in Pamplona, Spain, from April 2006 to April 2012. The SAPS II and SAPS 3 scores with respective predicted mortality rates were calculated according to standard coefficients. Discrimination was evaluated by calculating the area under receiver operating characteristic curve (AUROC) and calibration with the Hosmer-Lemeshow goodness of fit test. Standardized mortality ratios (SMR) with 95% confidence interval (95% CI) were calculated for each model.ResultsThe study included 607 patients. The observed in-hospital mortality was 20.1% resulting in a SMR of 0.87 (95% CI 0.73-1.04) for SAPS II and 0.56 (95% CI 0.47-0.67) for SAPS 3. Both scores showed acceptable discrimination, with an AUROC of 0.76 (95% CI 0.71-0.80) for SAPS II and 0.75 (95% CI 0.71- 0.80) for SAPS 3. Calibration curves showed similar performance based on Hosmer-Lemeshow goodness of fit C-test: (X2=12.9, p=0.113) for SAPS II and (X2=4.07, p=0.851) for SAPS 3.ConclusionsAlthough both scores overpredicted mortality, SAPS II showed better discrimination for patients admitted to ImCU in terms of SMR.

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“…At present hospitalists on staffs reach 50,000 physicians, more than cardiologists, in almost all medical centers in US [9][10][11][12]. The advantages of HOS include a more rapid, effective and precise dealing with problems no matter in diagnoses, prescription of medications, therapeutic strategies or the communications with patients by sharing decision making with attending physicians rather than by residency in advance [13,14]. Several studies have reported that HOS model at wards provides shorter length of stay and improves quality of care [11,[14][15][16].…”

Section: Application Of Integrated Medicalmentioning

confidence: 99%

Application of Integrated Medical Care Model (Hospitalist) in Emergency Department and its Efficiency and Outcome: 4 years' Experience in Taiwan

Weng¹,

Huang²,

Zhang³

et al. 2017

Health Care Current Reviews

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Background: The hospitalist model (HOS) setting at wards can improve quality of patient care and shorten length of stay, however, their efficacy at emergency department (ED) is still lacking in Taiwan.Objective: To realize if HOS is working at ED in a designed academic care program.Design/setting: Before-and-after intervention of HOS in a 1200-bed tertiary medical center in Taiwan. Measurement:A three-shift duty with 8 internal subspecialists was adapted for their working schedule in 3:1:1 physicians round. From 2012~2016, 4 years data was collected retrospectively such as length of stay, over-waiting (>48 h) period, mortality, 6 and 24 h deterioration after hospitalization and satisfaction questionnaire were analyzed before and after HOS intervention was compared.Results: There was no significant difference in patient number, age and sex before and after HOS program at ED. In total, 4 years data analyzed (520,409 ED visitors, 111,949 hospitalized) was shown that decline of waiting time, over-waiting (>48 h), mortality rate, post-hospitalized 6 and 24 h transferring to intensive care unit were statistically significant (ANOVA, p ≦ 0.05 individually). In average 55-60 patients per month discharged from holistic care unit without admission. Satisfactory questionnaire for pre-hospitalized care in disease explanation, service attitudes, symptom relief and overall impression about healthcare reached 90% in two times survey (427 and 459 sample sizes).Conclusion: HOS at ED can lessen over-crowded conditions, shorten pre-hospitalized length, decline mortality, and improve quality of care and patient satisfaction. Although data comes from a single medical center, it still shows good efficiency and outcome since HOS implemented at emergency. of care model, hospitalist program-HOS, was launched by the hospital administrators to solve the over-crowded situations and cared pre-hospitalized patients in advance at ED. Application of Integrated MedicalThe HOS was established in United Stated (US) in 1996 and the field of hospital medicine has grown rapidly worldwide recently. At present hospitalists on staffs reach 50,000 physicians, more than cardiologists, in almost all medical centers in US [9][10][11][12]. The advantages of HOS include a more rapid, effective and precise dealing with problems no matter in diagnoses, prescription of medications, therapeutic strategies or the communications with patients by sharing decision making with attending physicians rather than by residency in advance [13,14]. Several studies have reported that HOS model at wards provides shorter length of stay and improves quality of care [11,[14][15][16]. From patient point of views,

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Results of a retrospective observational study of intermediate care staffed by hospitalists: Impact on mortality, co‐management, and teaching

Cited by 20 publications

References 26 publications

Triage of Intermediate-Care Patients in Pediatric Hospitals

Triage of Intermediate-Care Patients in Pediatric Hospitals

Performance of SAPS II and SAPS 3 in Intermediate Care

Application of Integrated Medical Care Model (Hospitalist) in Emergency Department and its Efficiency and Outcome: 4 years' Experience in Taiwan

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