Analysis of intensive care populations to select possible candidates for high dependency care.

Abstract

Objectives-To identify the proportion, and range across intensive care units, of intensive care patients who might potentially be managed on a high dependency unit (HDU) using three different classification systems. Methods-8095 adult patients admitted to 15 intensive care units in the south of England between 1 April 1993 and 31 December 1994 were studied. Patients were identified as potential HDU admissions if their APACHE III derived risk of hospital mortality was s10%, if they were categorised as a low risk monitor (LRM) patient using the Wagner risk stratification method, or if they did not require advanced respiratory support (ARS).Results-4146 patients (51.2%) had an APACHE III derived risk of hospital death of < 10%, 1687 (20.8%) were classified as LRM, and 3860 (47.7%) did not receive ARS. The values for each intensive care unit ranged from 32.8-63.3% (APACHE III group), 7.2-29.9% (LRM group), and 14.4-68.2% (ARS group). No matter which of the three methods was used, there were significant differences between the 15 units (p<0.0001) with regard to the number of potential HDU patients identified within the scored population. Conclusions-The percentage of intensive care patients who might be more appropriately managed in a HDU varies considerably between hospitals, and depends upon both local circumstances and the method used to define a high dependency patient. However, whichever method is used, it appears that significant numbers of patients of low dependency status currently fill intensive care beds in the units studied. If these analyses are correct, the perceived national shortage in intensive care beds might be improved by the development of HDUs.

A retrospective cohort study of short-stay admissions to the medical intensive care unit: Defining patient characteristics and critical care resource utilization

“…In single-center studies, step-down units may decrease the number of low-risk monitor patients occupying ICU beds. [ 22 23 24 25 ] However, data regarding the impact of the availability of step-down unit care on patient outcomes is limited, and outcomes for medical patients admitted to step-down care as an alternative to full intensive care have not been well researched. [ 26 ] Second, in this study, we were unable to capture day-to-day variation in ICU and floor occupancy that would also affect patient throughput.…”

The Role of Stepdown Beds in Hospital Care

“…While guidelines may be helpful, there is still a very large grey area regarding appropriate SDU admissions. Moreover, studies suggest that ICUs are still often used for SDU-level care; an estimated 22-73% of ICU beds are occupied at any given time by intermediate-care level patients (5,17,(19)(20)(21).…”

“…Single-center studies have shown that the establishment of an SDU [1] may allow for more overall critical care admissions without an increase in mortality (27), [2] may shorten ICU length of stay without increasing ICU readmissions (19,39), and [3] may decrease the proportion of step-down patients residing in ICU beds (19,21,39,52). Whether or not these improvements are cost-effective is unclear; a systematic review of the literature by Keenan et al was unable to confirm improved cost-effectiveness with the use of SDUs (10).…”

Census of Ligurian Internal Medicine Wards of non-teaching hospitals

“…10 In United Kingdom HDAs development made the opposite path: in late 1990's, it appeared that significant numbers of patients of low dependency status filled intensive care beds, so they were implemented. 11 It is neither a substitute of the Emergency Medicine units, located in the Emergency Department, where unstable patients are cared for max 72 h as established by regulatory policy 12 -because Emergency Medicine is a time-dependent specialty and not a complexity-dependent specialty, such as Internal Medicine. 3 HDAs in Internal Medicine are instead an opportunity for the management of complex cases that cannot be treated in intensive care because they are not eligible, in relation to disease severity, age and comorbidities, although critically ill 13,14 with the advantage of avoiding discontinuations of care.…”