The effects of discharge to an intermediate care unit after a critical illness: A 5-year cohort study

Ranzani, Otávio T.; Zampieri, Fernando Godinho; Taniguchi, Leandro Utino; Forte, Daniel Neves; Azevedo, Luciano César Pontes; Park, Marcelo

doi:10.1016/j.jcrc.2013.10.013

Cited by 21 publications

(23 citation statements)

References 31 publications

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“…This percentage is not too different from that reported by Ranzani et al . who discharged 23% of their patients to IMCU [ 52 ]. Of note, the exclusion of the patients admitted to the 12 ICUs having a Coronary Care Unit as the only IMCU in the hospital did not change our results on hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study

et al. 2014

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IntroductionThe aim of the study was to assess whether adults admitted to hospitals with both Intensive Care Units (ICU) and Intermediate Care Units (IMCU) have lower in-hospital mortality than those admitted to ICUs without an IMCU.MethodsAn observational multinational cohort study performed on patients admitted to participating ICUs during a four-week period. IMCU was defined as any physically and administratively independent unit open 24 hours a day, seven days a week providing a level of care lower than an ICU but higher than a ward. Characteristics of hospitals, ICUs and patients admitted to study ICUs were recorded. The main outcome was all-cause in-hospital mortality until hospital discharge (censored at 90 days).ResultsOne hundred and sixty-seven ICUs from 17 European countries enrolled 5,834 patients. Overall, 1,113 (19.1%) patients died in the ICU and 1,397 died in hospital, with a total of 1,397 (23.9%) deaths. The illness severity was higher for patients in ICUs with an IMCU (median Simplified Acute Physiology Score (SAPS) II: 37) than for patients in ICUs without an IMCU (median SAPS II: 29, P <0.001). After adjustment for patient characteristics at admission such as illness severity, and ICU and hospital characteristics, the odds ratio of mortality was 0.63 (95% CI 0.45 to 0.88, P = 0.007) in favour of the presence of IMCU. The protective effect of the IMCU was absent in patients who were admitted for basic observation, for example, after surgery (odds ratio 1.15, 95% CI 0.65 to 2.03, P = 0.630) but was strong in patients admitted to an ICU for other reasons (odds ratio 0.54, 95% CI 0.37 to 0.80, P = 0.002).ConclusionsThe presence of an IMCU in the hospital is associated with significantly reduced adjusted hospital mortality for adults admitted to the ICU. This effect is relevant for the patients requiring full intensive treatment.Trial registrationClinicaltrials.gov NCT01422070. Registered 19 August 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0551-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study

et al. 2014

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“…In contrast, if intermediate care is predominantly used as step-up monitoring for ward patients, its emergence may raise costs without necessarily improving outcomes. Unfortunately, most studies to date examining the effect of intermediate care on patient outcomes and hospital costs are limited by single-center, pre-post, or retrospective designs, and have yielded mixed results (3)(4)(5)(6)(7).…”

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confidence: 99%

Rising Billing for Intermediate Intensive Care among Hospitalized Medicare Beneficiaries between 1996 and 2010

Sjoding¹,

Valley²,

Prescott

et al. 2016

Am J Respir Crit Care Med

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“…This setting can facilitate the discharge from the ICU prematurely to solve the problem of limited ICU beds, and the patients discharged to the step‐down unit tended to be more severely ill during their ICU stay than patients discharged directly to the general ward. However, in a recent propensity‐matched cohort study in Brazil, 90‐day mortality rate and ICU readmission rates were similar in patients who were discharged to the intermediate care unit [23]. In another European multinational cohort study, patients admitted to ICUs with an intermediate care unit in the hospital had reduced mortality in comparison with patients admitted to ICUs without an intermediate care unit [24].…”

Section: Discussionmentioning

confidence: 91%

Effects of a medical emergency team follow‐up programme on patients discharged from the medical intensive care unit to the general ward: a single‐centre experience

Choi

Lee

Shin

et al. 2015

Evaluation Clinical Practice

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The effects of discharge to an intermediate care unit after a critical illness: A 5-year cohort study

Cited by 21 publications

References 31 publications

Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study

Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study

Rising Billing for Intermediate Intensive Care among Hospitalized Medicare Beneficiaries between 1996 and 2010

Effects of a medical emergency team follow‐up programme on patients discharged from the medical intensive care unit to the general ward: a single‐centre experience

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