Assessment of the intermediate care unit triage system

Plate, Joost D J; Peelen, Linda M.; Leenen, Luke P. H.; Houwert, R Marijn; Hietbrink, Falco

doi:10.1136/tsaco-2018-000178

Cited by 9 publications

(10 citation statements)

References 19 publications

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“…Triage for admission is performed by the responsible medical team of the IMCU in collaboration with the admitting specialist. The efficiency and safety of the here-described IMCU is more extensively described in previous publications 10 11. It should be noted that, if IMCUs are not safe, they should not be used, regardless of their (potential) economic benefits.…”

Section: Methodsmentioning

confidence: 95%

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The intermediate care unit as a cost-reducing critical care facility in tertiary referral hospitals: a single-centre observational study

et al. 2019

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ObjectivesTo determine whether and to what extent the surgical intermediate care unit (IMCU) reduces healthcare costs.DesignRetrospective cohort study.SettingThe mixed-surgical IMCU of a tertiary academic referral hospital.ParticipantsAll admissions (n=2577) from 2012 to 2015.Primary and secondary outcome measuresThe outcome measure was the hypothetical cost savings due to the presence of the IMCU. For this, each admission day was classified as either low-acuity or high-acuity, based on the Therapeutic Intervention Scoring System-28, the required specific nursing interventions and the indication for admission at the IMCU. Costs (2018) used were €463 per hospital ward, €1307 per IMCU and €2224 per intensive care unit (ICU) admission day. Savings were calculated by subtracting the actual IMCU costs from the hypothetical costs in the absence of the IMCU.ResultsThere were 9037 admission days (n=2577 admissions) at the IMCU. The proportion of high-acuity admissions was 87.6%. Total costs at the IMCU were €11.808 888. Total hypothetical costs in absence of the IMCU were €18.115 284. Total cost savings were thus €6.306 395, or €1.576 599, per year.ConclusionsThe surgical IMCU may substantially reduce societal healthcare costs, making it a cost saving alternative to ICU care. Constant adequate triage is essential to optimise its potential.

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Section: Methodsmentioning

confidence: 95%

“…It has a nurse-to-patient ratio of 1:1.5, while the ICU has a nurse staffing of 1:1. This relatively high nurse-to-patient ratio allows for the admittance of more complex patients that require a high nursing workload 10. Nursing at the IMCU is performed by specific IMCU-trained nurses, while in the ICU specific ICU-trained nurses are present.…”

Section: Methodsmentioning

confidence: 99%

The intermediate care unit as a cost-reducing critical care facility in tertiary referral hospitals: a single-centre observational study

et al. 2019

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“…These units reduce the gap between the wards and ICU and can act as step-up units for deteriorating and step-down units for improving patients. 23 …”

Section: Discussionmentioning

confidence: 99%

The Detrimental Impact of the COVID-19 Pandemic on Major Trauma Outcomes in the Netherlands

et al. 2021

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Objective: To evaluate the impact of the COVID-19 pandemic on the outcome of major trauma patients in the Netherlands. Summary Background Data: Major trauma patients highly rely on immediate access to specialized services, including ICUs, shortages caused by the impact of the COVID-19 pandemic may influence their outcome. Methods: A multi-center observational cohort study, based on the Dutch National Trauma Registry was performed. Characteristics, resource usage, and outcome of major trauma patients (injury severity score ≥16) treated at all trauma-receiving hospitals during the first COVID-19 peak (March 23 through May 10) were compared with those treated from the same period in 2018 and 2019 (reference period). Results: During the peak period, 520 major trauma patients were admitted, versus 570 on average in the pre-COVID-19 years. Significantly fewer patients were admitted to ICU facilities during the peak than during the reference period (49.6% vs 55.8%; P =0.016). Patients with less severe traumatic brain injuries in particular were less often admitted to the ICU during the peak (40.5% vs 52.5%; P =0.005). Moreover, this subgroup showed an increased mortality compared to the reference period (13.5% vs 7.7%; P =0.044). These results were confirmed using multivariable logistic regression analyses. In addition, a significant increase in observed versus predicted mortality was recorded for patients who had a priori predicted mortality of 50% to 75% ( P =0.012). Conclusions: The COVID-19 peak had an adverse effect on trauma care as major trauma patients were less often admitted to ICU and specifically those with minor through moderate brain injury had higher mortality rates.

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“…While most IMCUs offer continuous monitoring of vital signs, the ability to provide mechanical ventilation, renal replacement therapy, and differentiated catecholamine therapy is normally limited [ 11 ]. Although IMCU patients commonly demand a higher level of nursing compared to the normal ward, the severity of illness is lower than on the ICU [ 12 , 13 ]. It is worth noting that the mere presence of an IMCU is associated with a significantly reduced hospital mortality in ICU patients, underlining the impact of an IMCU as a bridge between the ICU and the regular ward [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients

et al. 2020

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Background It is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) scores are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the regular ward. This study aimed to examine the ability of SOFA and qSOFA scores to predict suspected infection and mortality in IMCU patients. Methods Retrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between January 01, 2012, and September 30, 2018. Patients were screened for suspected infection (i.e., the commencement of broad-spectrum antibiotics) and then evaluated for the SOFA score, qSOFA score, and the 1992 defined systemic inflammatory response syndrome (SIRS) criteria. Results Suspected infection was detected in 1306 (18.3%) of IMCU, 1365 (35.5%) of ICU, and 1734 (62.0%) of IMCU/ICU encounters. Overall, 458 (3.3%) patients died (IMCU 45 [0.6%]; ICU 250 [6.5%]; IMCU/ICU 163 [5.8%]). All investigated scores failed to predict suspected infection independently of the analyzed subgroup. Regarding mortality prediction, the qSOFA score performed sufficiently within the IMCU cohort (AUCROC SIRS 0.72 [0.71–0.72]; SOFA 0.52 [0.51–0.53]; qSOFA 0.82 [0.79–0.84]), while the SOFA score was predictive in patients of the IMCU/ICU cohort (AUCROC SIRS 0.54 [0.53–0.54]; SOFA 0.73 [0.70–0.77]; qSOFA 0.59 [0.58–0.59]). Conclusions None of the assessed scores was sufficiently able to predict suspected infection in surgical ICU or IMCU patients. While the qSOFA score is appropriate for mortality prediction in IMCU patients, SOFA score prediction quality is increased in critically ill patients.

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Assessment of the intermediate care unit triage system

Cited by 9 publications

References 19 publications

The intermediate care unit as a cost-reducing critical care facility in tertiary referral hospitals: a single-centre observational study

The intermediate care unit as a cost-reducing critical care facility in tertiary referral hospitals: a single-centre observational study

The Detrimental Impact of the COVID-19 Pandemic on Major Trauma Outcomes in the Netherlands

Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients

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