Case Aaron S, Hochberg Chad H, Koirala Binu, Flanagan Eleni, Chatterjee Souvik, Checkley William N, Gurses Ayse P, Hager David N
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD.
School of Nursing, Johns Hopkins University, Baltimore, MD.
Crit Care Explor. 2025 Jan 22;7(1):e1201. doi: 10.1097/CCE.0000000000001201. eCollection 2025 Jan 1.
Intermediate care (IC) is prevalent nationwide, but little is known about how to best organize this level of care. Using a 99-item cross-sectional survey assessing four domains (hospital and physical IC features, provider and nurse staffing, monitoring, and interventions/services), we describe the organizational heterogeneity of IC within a five-hospital healthcare system. Surveys were completed by nurse managers from 12 (86%) of 14 IC settings. Six IC settings (50%) were embedded within acute care wards, four (33%) were stand-alone units, and two (17%) were embedded within an ICU. All had a nurse-to-patient ratio of 1:3, provided continuous cardiac telemetry, continuous pulse oximetry, high-flow nasal oxygen, and bedside intermittent hemodialysis. Most (> 50%) permitted arterial lines, frequent nursing assessments (every 2 hr), and noninvasive ventilation or mechanical ventilation via a tracheostomy. Vasopressors were less often permitted (< 25% of settings). Models of IC vary greatly within a single healthcare system.
中级护理（IC）在全国范围内普遍存在，但对于如何最佳地组织这一护理级别却知之甚少。我们通过一项包含99个项目的横断面调查，评估四个领域（医院和物理IC特征、医护人员配备、监测以及干预措施/服务），描述了一个五家医院的医疗系统内IC的组织异质性。来自14个IC科室中的12个（86%）的护士长完成了调查。六个IC科室（50%）嵌入在急性护理病房内，四个（33%）是独立单元，两个（17%）嵌入在重症监护病房内。所有科室的护士与患者比例均为1:3，提供持续心脏遥测、持续脉搏血氧饱和度监测、高流量鼻导管吸氧以及床边间歇性血液透析。大多数（>50%）允许使用动脉导管、频繁的护理评估（每2小时一次）以及通过气管造口进行无创通气或机械通气。血管活性药物的使用较少被允许（<25%的科室）。在单一医疗系统内，IC模式差异很大。
