Profiles of the patients admitted to intermediate care units in France: Admission criteria appropriateness and potential outcome benefits (UNISURC project part 2)

Background: The added value of Intermediate Care Units (IMCUs) remains controversial. This prospective, multicenter, observational cohort study aimed to: identify the characteristics of patients admitted and evaluate the appropriateness of IMCU stays according to criteria previously established in the UNISURC study; and describe the hospital trajectories and outcomes of patients admitted to IMCUs or not. Methods: Data were collected from 12 IMCUs in seven French hospitals. All patients admitted to the IMCU from the emergency department, after intensive care unit discharge (post-ICU) or post-surgery were followed for 7 days following study inclusion. Primary and secondary outcome measures were: mortality rate over 7 days postinclusion, demographic characteristics, IMCU-admission criteria, nursing workload assessed with the Nine Equivalents of nursing Manpower Score (NEMS). Results: Among 437 enrolled patients, 398 were analyzed, 260 of whom were admitted to IMCUs. IMCUadmission criteria were in close accordance with previous Delphi-survey selection items (56/63 items used). For emergency department, post-ICU and post-operative trajectories, respectively, median [IQR] SAPS II at IMCU entry were: 17 [12-24], 32 [26-53] and 19 [13-25] (p < 0.05), with respective NEMS of 16 [14-27], 15 [9-21] and 18 [15-21] (p = 0.071). Crude total 7-day mortality of patients with an IMCU stay was 13/260 (5 %), compared to 15/138 (10.8 %) of those without (p = 0.048). Conclusion: These observations provide a rationale supporting the contribution of IMCU implementation in hospitals caring for patients requiring critical-care trajectories.