Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Barbara CJ Solberg, Carmen D Dirksen, Fred HM Nieman, Godefridus van Merode, Graham Ramsay, Paul Roekaerts, Martijn Poeze

Published in: BMC Anesthesiology | Issue 1/2014

Login to get access

Abstract

Background

Improvement 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.

Method

In 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.

Results

During 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.

Conclusion

The IMC contributed to a more appropriate use of ICU facilities and did result in a significant increase in mean nursing workload at the ICU.
Appendix
Available only for authorised users
Literature
1.
Franklin C, Rackow EC, Mamdani B, Burke G, Weil MH: Triage considerations in medical intensive care. Arch Intern Med. 1990, 150: 1455-1459. 10.1001/archinte.1990.00390190105016.CrossRefPubMed
2.
Bone RC, McElwee NE, Eubanks DH, Gluck EH: Analysis of indications for early discharge from the intensive care unit. Clinical efficacy assessment project: American College of Physicians. Chest. 1993, 104 (6): 8112-8117.
3.
Beck DH, McQuillan P, Smith GB: Waiting for the break of dawn? The effect of discharge time, discharge TISS-28 scores and discharge facility on hospital mortality after intensive care. Intensive Care Med. 2002, 28: 1287-1293. 10.1007/s00134-002-1412-5.CrossRefPubMed
4.
Society of Critical Care Medicine Ethics Committee: Consensus statement on the triage of critically ill patients. JAMA. 1994, 271: 1200-1203. 10.1001/jama.1994.03510390070032.CrossRef
5.
Dawson S, Runk JA: Right patient? Right bed? A question of appropriateness. AACN Clin Issues. 2000, 11 (3): 375-385. 10.1097/00044067-200008000-00005.CrossRefPubMed
6.
Levin PD, Sprung CL: The process of intensive care triage. Intensive Care Med. 2001, 27 (9): 1441-1445. 10.1007/s001340101042.CrossRefPubMed
7.
Miranda MD, Spangenberg JFA: Quality, efficiency and organization of Intensive Care Units in the Netherlands. 1992, the Netherlands, Den Haag: Elsevier
8.
Zimmerman JE, Wagner DP, Knaus WA, Williams JF, Kolakowski D, Drapper EA: The use of risk predictions to identify candidates for intermediate care units. Chest. 1995, 108: 490-499. 10.1378/chest.108.2.490.CrossRefPubMed
9.
Ridly SA: Intermediate care. Possibilities, requirements and solutions. Anaesthesia. 1998, 53: 654-664. 10.1046/j.1365-2044.1998.466-az0557.x.CrossRef
10.
Byrick RJ, Mazer CD, Caskennette GM: Closure of an intermediate care unit: impact on critical care utilization. Chest. 1993, 104: 876-881. 10.1378/chest.104.3.876.CrossRefPubMed
11.
Bertolini G, Confalonieri M, Rossi C, Rossi G, Simini B, Gorini M, Corrado A, GiViTI (Gruppo italiano per la Valutazione degli interventi in Terapia Intensiva) Group; Aipo (Associazione Italiana Pneumologi Ospedalieri) Group: Costs of the COPD between intensive care unit and respiratory intermediate care unit. Respir Med. 2005, 99: 894-900. 10.1016/j.rmed.2004.11.014.CrossRefPubMed
12.
Cheng DCH, Byrick RJ, Knobel E: Structural models for intermediate care areas. Crit Care Med. 1990, 27 (10): 2266-2271.CrossRef
13.
Task force of the American College of Critical Care Medicine, Society of Critical Care Medicine: Guidelines for ICU admission, discharge and triage. Crit Care Med. 1999, 27 (3): 633-638. 10.1097/00003246-199903000-00048.CrossRef
14.
Task force of the American College of Critical Care Medicine, Society of Critical Care Medicine: Guidelines on admission and discharge for adult intermediate care u. Crit Care Med. 1998, 26 (3): 607-610. 10.1097/00003246-199803000-00039.CrossRef
15.
Keenan SP, Doig GS, Martin CM, Inman KJ, Sibbald WJ: Assessing the efficiency of the admission process to a critical care unit: does the literature allow the use of benchmarking?. Intensive Care Med. 1997, 23: 574-580. 10.1007/s001340050375.CrossRefPubMed
16.
Subbe CP, Kruger M, Rutherford P, Gemmel L: Validation of a modified Early Warning Score in medical admissions. QJM. 2001, 94: 521-526. 10.1093/qjmed/94.10.521.CrossRefPubMed
17.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med. 1985, 13: 818-829. 10.1097/00003246-198510000-00009.CrossRefPubMed
18.
Reis Miranda D, de Rijk A, Schaufeli W: Simplified therapeutic intervention Scoring system: the TISS-28 items – results from a multicenter study. Crit Care Med. 1997, 24: 64-73.CrossRef
19.
Kwok WWY, Chau JPC, Le Low LP, Thompson DR: The reliability and validity of the therapeutic activity index. J Crit Care. 2005, 20 (3): 257-263. 10.1016/j.jcrc.2005.06.004.CrossRef
20.
Pirret AM: Utilizing TISS to differentiate between intensive care and high-dependency patients and to identify nursing skill requirements. Intensive Crit Care Nurs. 2002, 18: 19-26. 10.1054/iccn.2002.1617.CrossRefPubMed
21.
Morrice A, Simpson HJ: Identifying level one patients. A cross-sectional survey on an in-patient hospital population. Intensive Crit Care Nurs. 2007, 23: 23-32. 10.1016/j.iccn.2006.07.001.CrossRefPubMed
22.
Fox AJ, Owen-Smith O, Spiers P: The immediate impact of opening an adult high dependency unit on intensive care unit occupancy. Anaesthesia. 1999, 54: 266-296. 10.1046/j.1365-2044.1999.00335.x.CrossRef
23.
Kastrup M, Seeling M, Barthel S, Bloch A, le Claire M, Spies C, Scheller M, Braun J: Effects of intensivist coverage in a post-anaesthesia care unit on surgical patients’ case mix and characteristics of the intensive care unit. Crit Care. 2012, 16: R126-10.1186/cc11428.CrossRefPubMedPubMedCentral
24.
Eachempati SR, Hydo LJ, Barie PS: The effect of an intermediate care unit on the demographics and outcomes of a surgical intensive care unit population. Arch Surg. 2004, 139 (3): 315-319. 10.1001/archsurg.139.3.315.CrossRefPubMed
25.
Gajic O, Malinchoc M, Comfere TB, Harris MR, Achouiti A, Yilmaz M, Schultz MJ, Hubmayr RD, Afessa B, Farmer JC: The Stability and Workload Index for Transfer score predicts unplanned intensive care unit patient readmission: initial development and validation. Crit Care Med. 2008, 36 (3): 676-682. 10.1097/CCM.0B013E318164E3B0.CrossRefPubMed
26.
Cooper GS, Sirio CA, Rotondi AJ, Shepardson LB, Rosenthal GE: Are readmissions to the intensive care unit a useful measure of hospital performance?. Med Care. 1999, 37 (4): 399-408. 10.1097/00005650-199904000-00009.CrossRefPubMed
27.
Metnitz PG, Fieux F, Jordan B, Lang T, Moreno R, Le Gall JR: Critically ill patients readmitted to intensive care units–lessons to learn?. Intensive Care Med. 2003, 29 (2): 241-248.CrossRefPubMed
Metadata
Title
Introducing an integrated intermediate care unit improves ICU utilization: a prospective intervention study
Authors
Barbara CJ Solberg
Carmen D Dirksen
Fred HM Nieman
Godefridus van Merode
Graham Ramsay
Paul Roekaerts
Martijn Poeze
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2014
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/1471-2253-14-76

Other articles of this Issue 1/2014

BMC Anesthesiology 1/2014 Go to the issue

Research article

The combination of MELD score and ICG liver testing predicts length of stay in the ICU and hospital mortality in liver transplant recipients

Research article

The role of plasma gelsolin in cardiopulmonary bypass induced acute lung injury in infants and young children: a pilot study

Debate

Liberal or restricted fluid administration: are we ready for a proposal of a restricted intraoperative approach?

Research article

Dynamic preload indicators decrease when the abdomen is opened

Research article

Evaluation of the PaO2/FiO2 ratio after cardiac surgery as a predictor of outcome during hospital stay

Research article

Transcranial Doppler to assess sepsis-associated encephalopathy in critically ill patients