Intermediate care units

Waydhas, Christian; Herting, Egbert; Kluge, Stefan; Markewitz, Andreas; Marx, Gernot; Muhl, Elke; Nicolai, T.; Notz, K.J.; Parvu, Valentin; Quintel, Michael; Rickels, E.; Schneider, Dulcinéia Ghizoni; Steinmeyer-Bauer, K. R.; Sybrecht, Gerhard W.; Welte, Tobias

doi:10.1007/s00063-017-0369-7

“…1. Set up the Cohort Intermediate Care Unit (Cohort IMCU) 19,20 The Cohort IMCU has developed as specialized unit that providing an intermediate level of care between a Cohort ward and ICU for patients with COVID-19 whose conditions are clinically unstable. Their illness requires continuous vital signs monitoring for ensuring patient safety but no need mechanical ventilation with the following steps: 1.2 Rapidly developing protocols and guidance for healthcare personnel.…”

Section: A Professional Nursing Organization's Responsiveness To the Covid-19 Pandemic Situationmentioning

confidence: 99%

Fast Facts: Gene Therapy A new therapeutic direction?

Herzog¹,

Popplewell²

2021

bkkmedj

0

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To share experiences for the Cohort Intermediate Care Unit (IMCU) setup description. It also involves the focusing on integrated nursing care in collaboration with Multi-professional team to improve patient outcomes. MATERIALS AND METHODS:We collected and searched many articles from the published medical literature that reported standard protocols for the IMCU and nursing management of SARS-CoV-2 (COVID-19). This study was a collection of data from COVID-19 patients who were confirmed cases with positive real time-PCR test results. They were receiving treatment and admitted at Bangkok Hospital Headquarters (BHQ) from May 1 st -June 30 th , 2021. Descriptive statistics were used to describe the results in frequency, percentage and mean. We compared the average number of days for COVID-19 patients stay between two groups. A confidence interval (CI) was used to explain a different sample proportion and a different interval of hospital mortality rate. RESULT: Among 122 COVID-19 patients, 41 (33.6%) patients were admitted to the Cohort IMCU. The average length of stay (LoS) was 5.1 days, with minimum 1 day and maximum 15 days. Three quarter of them (31/41, 75.6%) had clinical improvement and were transferred to Cohort ward, while a quarter (10/41, 24.4%) had experienced clinical deterioration and were transferred to intensive care unit (ICU). Mortality rate of this group was 4.9% (95%CI -1.7, 11.5). During the same time period, 81 COVID-19 patients were directly transferred to ICU. The average LoS in ICU of 6.2 days. Among them, 8 of 81 patients did not survive. As a result, mortality rate among this group was 9.9% (95%CI 3.4, 16.4). CONCLUSION: In our experience, the Cohort IMCU can reduce mortality rate of the COVID-19 patients and proper management also decrease crowding of ICU.

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“…Intermediate care units (IMCUs) are logistically situated between ICUs and general wards and serve as an alternative care setting for patients deemed too unstable to be cared for on the general ward, but without requiring the resources of an ICU [8][9][10]. Lacking an unitary de nition of IMCUs, their nomenclature varies from high dependency, progressive care, medium care, or step-down units, resulting in a high variability of organizational practice [11].…”

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

Koch¹,

Edinger

²

,

Fischer

³

et al. 2020

Preprint

0

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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) score 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 sepsis and mortality in IMCU patients. Methods Retrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between 01/01/2012 and 09/30/2018. 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 1,306 (18.3%) of IMCU, 1,365 (35.5%) of ICU, and 1,734 (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 sepsis 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 sepsis in surgical ICU or IMCU patients with suspected infection. 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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“…Intermediate care units (IMCUs) are logistically situated between ICUs and general wards and serve as an alternative care setting for patients deemed too unstable to be cared for on the general ward, but without requiring the resources of an ICU [8][9][10]. Lacking an unitary de nition of IMCUs, their nomenclature varies from high dependency, progressive care, medium care, or step-down units, resulting in a high variability of organizational practice [11].…”

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

Koch

¹

,

Edinger

²

,

Fischer

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

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) score 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 sepsis and mortality in IMCU patients. Methods Retrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between 01/01/2012 and 09/30/2018. 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 1,306 (18.3%) of IMCU, 1,365 (35.5%) of ICU, and 1,734 (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 sepsis 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 sepsis in surgical ICU or IMCU patients with suspected infection. 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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Intermediate care units

Cited by 31 publications

References 23 publications

Fast Facts: Gene Therapy A new therapeutic direction?

Fast Facts: Gene Therapy A new therapeutic direction?

Comparison of qSOFA Score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients

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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