The role of an intermediate care unit in reducing intensive care unit admissions and improving patient outcomes in internal medicine: A quasi-experimental study.

Abstract

Background: Effective management of non-intensive critical patients is crucial, especially in hospitals with limited Intensive Care Unit (ICU) capacity. This study explores the impact of introducing a medical Intermediate Care Unit (IMCU) within an Internal Medicine ward on patient management outcomes.

Methods: A quasi-experimental study was conducted at Alto Vicentino Hospital in Italy, spanning January 2018 to July 2024. The Interrupted Time Series Analysis (ITSA) assessed the IMCU's effects on ICU admissions, transfers from the Internal Medicine ward to the ICU, hospital length of stay, and outpatient service volume. Monthly data were analyzed, comparing pre- and post-IMCU implementation periods.

Results: Post-IMCU implementation, ITSA revealed a significant decrease in ICU transfers, with a reduction of 2.02 per 100 admissions per month (p = 0.001). Hospital length of stay also declined by an average of 2.29 days (p < 0.001). ICU admissions from the Emergency Department dropped significantly from 3.3 to 2.6 per 1000 visits (p = 0.006). Outpatient services per physician markedly increased from 25.5 to 63.9 per month (p < 0.001). There was no significant change in 30-day mortality.

Conclusions: The integration of the IMCU into the Internal Medicine ward appears to have contributed to a reduction in ICU demand and facilitated quicker patient stabilization. These changes may have supported an increase in outpatient services, highlighting the IMCU's potential to aid in the management of non-intensive critical patients. However, further studies are needed to confirm these findings and evaluate their applicability in other contexts.