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

Area of Science:

• Critical Care Medicine
• Healthcare Management
• Hospital Operations

Background:

• Optimizing intensive care unit (ICU) capacity requires improving appropriate bed use and access.
• Intermediate care units (IMCs) integrated within ICUs may enhance ICU bed utilization.

Purpose of the Study:

• To evaluate the impact of introducing a six-bed intermediate care unit (IMC) on ICU utilization, nursing workload, and clinical outcomes.
• To assess changes in appropriate bed use, ICU accessibility, readmission, and mortality rates.

Main Methods:

• A before-after prospective intervention study was conducted in a university hospital mixed ICU.
• Data collected over 17 months included ICU utilization, mechanical ventilation use, nursing workload (TISS-28), referrals, readmissions, and mortality.

Main Results:

• ICU utilization improved, with a significant increase in appropriate ICU bed use.
• The number of referrals, ICU readmissions, and mortality rates did not decrease post-IMC implementation.
• Mean nursing workload in the ICU significantly increased.

Conclusions:

• The integrated intermediate care unit (IMC) facilitated more appropriate utilization of ICU facilities.
• While improving bed allocation, the IMC did not reduce patient referrals or mortality and increased nursing workload.