Joint management format at the mixed-surgical intermediate care unit: an interrupted time series analysis

Abstract

BackgroundThe management format of the mixed-surgical intermediate care unit (IMCU) affects its performance. A format of combined supervision of surgeons with additional critical care certifications and admitting specialists, named the “joint format”, may herein be a promising new model of specialized critical care. This study aims to assess the performance of the joint management format.MethodsThis observational cohort study compared three IMCU management formats at the stand-alone, mixed-surgical IMCU of a tertiary referral hospital using interrupted time series analyses. All admissions from 2001 until 2015 were included. Predetermined criteria for performance (utilization, efficiency, and safety) were applied to three different management format periods: open (2001–2006), closed (2006–2011), and joint (2011–2015) formats.ResultsA total of 8894 admissions were analyzed. In terms of case load (utilization), there was an overall increase in the number of surgical patients (0.25%/year) (p<0.001), age (0.38/year) (p<0.001), and readmissions from the ward (0.16%/year) (p<0.001) and from the intensive care unit (ICU) (0.17%/year) (p=0.014). In terms of efficiency, the admission duration decreased (1.58 hours/year) (p<0.001). Transfer to the ICU within 24 hours, readmission within 24 hours from the ward, and unplanned mortality (eg, safety) did not change over time.DiscussionAt a time of increasingly complex case load, the joint format at the mixed-surgical IMCU is an efficient and safe management format in which the admitting specialist continues to provide specialized care. Specialty-specific supervision at IMCUs is a safe option which should be considered in healthcare policy decisions.Level of evidenceLevel IV.

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

“…Second, we did not model entire patient trajectories of hospital stay and therefore we did not incorporate the effect of the IMCU or ICU on total hospital (or critical care) days and costs, for example, it may be that, in the absence of the IMCU, the same ICU-admitted patients are discharged from the hospital earlier, reducing total costs. Third, it is important to realise that this study does not account for patient outcomes (eg, mortality), but we have shown before that within this study period patient outcomes were satisfactory, that is, adverse events (IMCU mortality and ICU transfer) were uncommon 11. Fourth, since the organisation of intermediate care differs per hospital, adequate triage to mainly admit high-acuity patients is essential to justly generalise these results to other intermediate care settings.…”

“…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.…”

Assessment of the intermediate care unit triage system

“…This supplements earlier research within the same IMCU, which showed that the joint format has an equal efficiency and safety (with a more complex caseload) compared with other formats. 12 …”