Kistler Emmett A, Klatt Elaine, Raffa Jesse D, West Phyllis, Fitzgerald Jacqueline A, Barsamian Jennifer, Rollins Scott, Clements Charlotte M, Hickox Murray Shelby, Cocchi Michael N, Yang Julius, Hayes Margaret M
Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Fellowship in Patient Safety and Quality, Harvard Medical School, Boston, MA.
Crit Care Explor. 2023 Oct 18;5(10):e0994. doi: 10.1097/CCE.0000000000000994. eCollection 2023 Oct.
ICU capacity strain is associated with worsened outcomes. Intermediate care units (IMCs) comprise one potential option to offload ICUs while providing appropriate care for intermediate acuity patients, but their impact on ICU capacity has not been thoroughly characterized. The aims of this study are to describe the creation of a medical-surgical IMC and assess how the IMC affected ICU capacity.
Descriptive report with retrospective cohort review.
Six hundred seventy-three-bed tertiary care academic medical center with 77 ICU beds.
Adult inpatients who were admitted to the IMC.
An interdisciplinary working group created an IMC which was located on a general ward. The IMC was staffed by hospitalists and surgeons and supported by critical care consultants. The initial maximum census was three, but this number increased to six in response to heightened critical care demand. IMC admission criteria also expanded to include advanced noninvasive respiratory support defined as patients requiring high-flow nasal cannula, noninvasive positive pressure ventilation, or mechanical ventilation in patients with tracheostomies.
The primary outcome entailed the number of ICU bed-days saved. Adverse outcomes, including ICU transfer, intubation, and death, were also recorded. From August 2021 to July 2022, 230 patients were admitted to the IMC. The most frequent IMC indications were respiratory support for medical patients and post-operative care for surgical patients. A total of 1023 ICU bed-days were made available. Most patients were discharged from the IMC to a general ward, while 8% of all patients required transfer to an ICU within 48 hours of admission. Intubation (2%) and death (1%) occurred infrequently within 48 hours of admission. Respiratory support was the indication associated with the most ICU transfers.
Despite a modest daily census, an IMC generated substantial ICU bed capacity during a time of peak critical care demand.
重症监护病房（ICU）的容量压力与预后恶化相关。中级护理单元（IMC）是一种潜在的选择，可在为中度急性病患者提供适当护理的同时减轻ICU的负担，但它们对ICU容量的影响尚未得到充分描述。本研究的目的是描述一个内科-外科IMC的创建过程，并评估IMC对ICU容量的影响。
带有回顾性队列审查的描述性报告。
一家拥有673张床位的三级医疗学术医学中心，设有７７张ICU床位。
入住IMC 的成年住院患者。
一个跨学科工作组创建了一个位于普通病房的IMC。IMC由住院医师和外科医生配备人员，并由重症监护顾问提供支持。最初的最大普查人数为三人，但由于重症监护需求增加，这一数字增加到了六人。IMC的入院标准也扩大到包括高级无创呼吸支持，即需要高流量鼻导管、无创正压通气或气管切开患者的机械通气的患者。
主要结果涉及节省的ICU床日数。还记录了不良结果，包括转入ICU、插管和死亡。从2021年8月到2022年7月，230名患者入住了IMC。IMC最常见的适应症是内科患者的呼吸支持和外科患者的术后护理。总共提供了1023个ICU床日。大多数患者从IMC出院后转入普通病房，而8%的患者在入院后48小时内需要转入ICU。插管（2%）和死亡（1%）在入院后4８小时内很少发生。呼吸支持是与转入ICU最相关的适应症。
尽管每日普查人数不多，但在重症监护需求高峰期，一个IMC产生了大量的ICU床位容量。
