Your browser doesn't support javascript.
Creation and Evaluation of a Mixed Service Intermediate Care Unit with Obligate Critical Care Consultation to Improve ICU Capacity
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927771
ABSTRACT
Rationale Significant capacity constraints brought on by the COVID-19 pandemic have underscored the need for novel staffing models that offload ICUs while still providing appropriate standard of care for high acuity patients. Intermediate Care Units (IMCs) provide one such outlet that have not been extensively examined, particularly during the COVID-19 era. Here we describe a quality improvement project focused on the creation of a mixed IMC with critical care support at our institution during the COVID-19 pandemic.

Methods:

With the support of institutional leadership, an interprofessional working group spanning critical care, surgery, hospital medicine, nursing, and respiratory therapy was convened to establish the staffing model, determine inclusion/exclusion criteria, and track IMC progress. The initial model entailed a medical-surgical service unit staffed by intermediate care-trained nurses, primary teams comprised of hospitalists or surgical teams, and an intensivist who rounded daily. All medical patients received an automatic critical care support consult;all surgical patients had the option of this consult. The maximum census was three. A retrospective chart review was conducted at the end of the initial phase to evaluate process, outcome, and balancing measures. Data were reported using simple descriptive statistics.

Results:

From August 9th to October 15th 2021, 36 patients - 21 medical and 15 surgical - were admitted to the IMC. The average age was 62.4, 17 (47.2%) were female, and 11 (30.5%) were admitted for COVID-19. The most frequent indications were hypoxemia (15, 71.4%) for medical patients and post-operative monitoring (12, 80%) for surgical patients. The average length of stay was 2.5 days. Most patients stepped down from an ICU or PACU rather than stepping up from a general ward or emergency department. A total of 577 ICU bed-hours were made available by admitting patients to the IMC who would have otherwise occupied an ICU bed. Seven medical patients (33.3%) required transfer back to an ICU and one medical patient (4.8%) transitioned to hospice. The remaining 13 (61.1%) medical and 14 (93.3%) surgical patients were discharged to a general ward. One patient was intubated within 48 hours of triage to the IMC, and zero patients expired while admitted to the IMC.

Conclusions:

Creation of an IMC provided a means to care for high acuity patients while creating ICU capacity. Subsequent phases will expand on inclusion criteria and maximum census while assessing the effect of critical care support consults on patient safety and hospitalist and intensivist workloads.
Keywords

Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: American Journal of Respiratory and Critical Care Medicine Year: 2022 Document Type: Article

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: Databases of international organizations Database: EMBASE Type of study: Experimental Studies Language: English Journal: American Journal of Respiratory and Critical Care Medicine Year: 2022 Document Type: Article