Opening of a Respiratory Intermediate Care Unit in a General Hospital: Impact on Mortality and Other Outcomes

Abstract

Background: Respiratory intermediate care units (RICUs) are specialized areas aimed at optimizing the cost-benefit ratio of care. No data exist about the impact of opening a RICU on hospital outcomes. Objectives: We wondered if opening a RICU may improve the outcomes of patients with acute respiratory failure (ARF), acute exacerbation of chronic obstructive pulmonary disease (AECOPD), or community-acquired pneumonia (CAP). Methods: We analyzed the discharge abstracts of 2,372 admissions to the RICU and internal medicine units (IMUs) for ARF, AECOPD, and CAP. The IMUs at the Hospital of Trieste comprise emergency and internal wards. In order to investigate the determinants of outcomes, a matched case-control study was performed using clinical records. Results: The in-hospital mortality rate was lower in the RICU vs. IMUs (5.4 vs. 19.1%, p = 0.0001). Statistical differences did not change when comparing the RICU with the emergency and internal wards. After adjusting for potential confounders, the risk of death for patients with CAP, AECOPD, or ARF was significantly higher in the IMUs than in the RICU (OR 6.90, 3.19, and 6.7, respectively, p < 0.04). Both the frequency of transfer to the ICU (6 vs. 12%, p = 0.0001, OR 0.38) and the hospital stay (9.3 vs. 12.1 days, p = 0.0001) were reduced in patients admitted to the RICU compared to those admitted to non-RICUs. Significant differences were found in care management concerning chest physiotherapy, mechanical ventilation, antibiotics, and corticosteroids. Conclusions: The opening of a RICU may be advantageous to reduce in-hospital mortality, the need for ICU admission, and the hospital stay of patients with AECOPD, CAP, and ARF. Better use of care resources contributed to better patient management in the RICU.

Different characteristics associated with intensive care unit transfer from the medical ward between patients with acute exacerbations of chronic obstructive pulmonary disease with and without pneumonia

“…Also recently, respiratory intermediate care units (RICUs) can provide an effective NIV application to patients have been introduced in Europe (31). Moreover, RICUs have the advantages to reduce hospital mortality, need for ICU admission, and hospital stay (32). In the present study, NIV was used more in the ICU group than ward group (data was not shown).…”

Impact of Telemedicine on Mortality, Length of Stay, and Cost Among Patients in Progressive Care Units: Experience From a Large Healthcare System*

“…Little formal investigation exists to describe and evaluate the effectiveness of PCUs ( 3 ). It is hypothesized that ICU services, bed utilization, and patient care outcomes may be positively impacted through use of PCUs ( 4 , 33 – 35 ); similarly Tele-ICU has shown to impact these factors positively ( 10 , 11 , 13 – 15 , 36 ) and therefore, Tele-PCU may also provide a distinct advantage. We found that PCU and hospital mortality rates were significantly lower for patients in TPCU group, compared with patients in NTPCUs.…”

Outcomes of Prolonged Mechanical Ventilation Before and After Implementation of a Respiratory ICU

“…Implementing RICUs in general hospitals has been found to reduce in-hospital mortality and LOS of subjects with acute respiratory diseases. 20 The pathway of admission in a RICU is a major determinant of patient outcomes. 21 It may be classified as follows: step-down pathway, which corresponds to an admission from an ICU; step-up pathway, which corresponds to an admission from a hospital ward; or direct pathway, which corresponds to an admission from the emergency department.…”