Introducing an integrated intermediate care unit improves ICU utilization: a prospective intervention study

被引:41
作者
Solberg, Barbara C. J. [1 ]
Dirksen, Carmen D. [2 ]
Nieman, Fred H. M. [2 ]
van Merode, Godefridus [3 ]
Ramsay, Graham [4 ]
Roekaerts, Paul [5 ]
Poeze, Martijn [4 ,5 ]
机构
[1] Maastricht Univ Med Ctr, Staff Dept Qual & Safety, NL-6229 HX Maastricht, Netherlands
[2] Maastricht Univ Med Ctr, Clin Epidemiol & Med Technol Assessment KEMTA, NL-6229 HX Maastricht, Netherlands
[3] Univ Maastricht, Dept Hlth Org Policy & Econ BEOZ, NL-6200 MD Maastricht, Netherlands
[4] Maastricht Univ Med Ctr, Dept Surg, NL-6229 HX Maastricht, Netherlands
[5] Maastricht Univ Med Ctr, Dept Intens Care Med, NL-6229 HX Maastricht, Netherlands
来源
BMC ANESTHESIOLOGY | 2014年 / 14卷
关键词
Intensive care; Efficiency; Intermediate care; Resource allocation; Hospital bed capacity; CRITICALLY-ILL PATIENTS; INTENSIVE-CARE; DISCHARGE; ADMISSION; VALIDATION; GUIDELINES; SYSTEM; TRIAGE; INDEX; SCORE;
D O I
10.1186/1471-2253-14-76
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Improvement of appropriate bed use and access to intensive care (ICU) beds is essential in optimizing utilization of ICU capacity. The introduction of an intermediate care unit (IMC) integrated in the ICU care may improve this utilization. Method: In a before-after prospective intervention study in a university hospital mixed ICU, the impact of introducing a six-bed mixed IMC unit supervised and staffed by ICU physicians was investigated. Changes in ICU utilization (length of stay, frequency of mechanical ventilation use), nursing workload assessed by TISS-28 score, as well as inappropriate bed use, accessibility of the ICU (number of referrals), and clinical outcome indicators (readmission and mortality rates) were measured. Results: During 17 months, data of 1027 ICU patients were collected. ICU utilization improved significantly with an increased appropriate use of ICU beds. However, the number of referrals, readmissions to the ICU and mortality rates did not decrease after the IMC was opened. Conclusion: The IMC contributed to a more appropriate use of ICU facilities and did result in a significant increase in mean nursing workload at the ICU.
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页数:7
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