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

BMC Anesthesiology

Research Article

Fred HM Nieman¹  Carmen D Dirksen¹  Godefridus van Merode²  Paul Roekaerts³  Martijn Poeze⁴  Graham Ramsay⁵  Barbara CJ Solberg⁶ 

[1] Clinical Epidemiology & Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands;Department of Health Organisation, Policy and Economics (BEOZ), University of Maastricht, P.O. Box 616, 6200, Maastricht, MD, The Netherlands;Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands;Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands;Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands;Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands;Regent House, Mittre Way, Battle, East Sussex, UK;Staff department of Quality and Safety, Maastricht University Medical Center, P. Debyelaan 25, 6229, Maastricht, HX, The Netherlands;

关键词: Intensive care;    Efficiency;    Intermediate care;    Resource allocation;    Hospital bed capacity;   

DOI  :  10.1186/1471-2253-14-76

 received in 2013-05-14, accepted in 2014-08-19,  发布年份 2014

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Solberg et al.; licensee BioMed Central Ltd. 2014