Intermediate Care Units in Internal Medicine.

Abstract

Background: Intermediate Care Units (ImCU) have been historically described as an intermediate level of care between standard wards and intensive care units (ICU), and general medical ImCUs have evolved as specifically addressed to high care medical patients. The objective of this study is to explore designs, appropriateness criteria, and quality of care of general medical ImCUs.

Methods: a comprehensive literature search was performed in electronic database (PubMed/Medline, Embase, Cochrane and Web of Science) up to July 30th 2024 and data about general medical ImCU denominations, settings, processes and outcomes were extracted.

Results: 34 studies were included in systematic analyses, the more used nomenclature was ImCU (70.6 %), followed by High Dependency Unit (20.6 %). The median number of beds was 8 [4-11], the nurse-to-patients ratio 1:3.1, and internists involved in comanagement in 40.0 %. Either a step-up from standard wards or a step-down from ICUs role were reported, with a median of 50.8 % [26.2-71.0] of patients directly admitted from Emergency Departments. The main distinctive activities were continuous monitoring and non-invasive ventilation. The median ICU transfer rate was 8.0 % [5.6-12.3], while in-ImCU and in-hospital mortality were 6.2 % [3.6-8.3] and 14.0 % [8.7-19.1], respectively.

Conclusions: general medical ImCUs are being increasingly recognized as the appropriate setting for high care medical patients but present to date a wide variability of formats. Activity-based admission criteria tailored on each hospital reality could be a process model for adequate patient flow, and quality of care key indicators should consider the functional general medical ImCU role in hospital macro-systems.