Intermediate care units: an effective alternative to reduce intensive care unit admissions-a prospective cohort study.

IF 3.8 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Internal and Emergency Medicine Pub Date : 2025-08-19 DOI:10.1007/s11739-025-04083-2

Gianni Turcato, Arian Zaboli, Alessandro Cipriano, Paolo Ferretto, Fabrizio Lucente, Lucia Filippi, Michael Maggi, Massimo Marchetti, Christian Josef Wiedermann, Lorenzo Ghiadoni

{"title":"Intermediate care units: an effective alternative to reduce intensive care unit admissions-a prospective cohort study.","authors":"Gianni Turcato, Arian Zaboli, Alessandro Cipriano, Paolo Ferretto, Fabrizio Lucente, Lucia Filippi, Michael Maggi, Massimo Marchetti, Christian Josef Wiedermann, Lorenzo Ghiadoni","doi":"10.1007/s11739-025-04083-2","DOIUrl":null,"url":null,"abstract":"Background: Critically ill medical patients from the Emergency Department (ED) are admitted either to general wards or the Intensive Care Unit (ICU). This binary allocation may lead to suboptimal management of non-intensive critical patients, increasing ICU overcrowding. Intermediate Care Units (IMCUs) could be an effective alternative, but their ability to reduce avoidable ICU admissions remains unclear.Aim: To evaluate whether an IMCU could effectively manage acutely ill patients with potential ICU treatment needs and to assess its role in reducing avoidable ICU admissions while maintaining patient outcomes.Methods: This prospective observational study (January-December 2024) was conducted at the IMCU of Alto Vicentino Hospital, Santorso, Italy. All acute patients admitted to the IMCU were included, excluding step-down ICU transfers. Clinical characteristics, disease severity, and organ dysfunction were recorded. Patients were classified based on their potential ICU treatment need, and ICU exclusion criteria were documented. Primary outcomes were ICU transfer due to IMCU failure and 30-day mortality.Results: Among 678 patients, 40.4% (274/678) had potential ICU treatment needs. Overall, 92.6% had organ failure, and 41.3% had multiple organ dysfunctions. IMCU management avoided ICU admission in 203 of 274 patients (79.9%). ICU transfer rate was 6.9% (47/678), and 30-day mortality was 12.8% (87/678). Among ICU-potential patients, mortality was 16.4% (45/274), decreasing to 11.4% (27/236) in those without ICU exclusion criteria.Conclusions: These findings suggest that IMCUs may serve as an effective alternative for managing critically ill non-intensive care patients, reducing avoidable ICU admissions while maintaining clinical outcomes.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Internal and Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11739-025-04083-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Critically ill medical patients from the Emergency Department (ED) are admitted either to general wards or the Intensive Care Unit (ICU). This binary allocation may lead to suboptimal management of non-intensive critical patients, increasing ICU overcrowding. Intermediate Care Units (IMCUs) could be an effective alternative, but their ability to reduce avoidable ICU admissions remains unclear.

Aim: To evaluate whether an IMCU could effectively manage acutely ill patients with potential ICU treatment needs and to assess its role in reducing avoidable ICU admissions while maintaining patient outcomes.

Methods: This prospective observational study (January-December 2024) was conducted at the IMCU of Alto Vicentino Hospital, Santorso, Italy. All acute patients admitted to the IMCU were included, excluding step-down ICU transfers. Clinical characteristics, disease severity, and organ dysfunction were recorded. Patients were classified based on their potential ICU treatment need, and ICU exclusion criteria were documented. Primary outcomes were ICU transfer due to IMCU failure and 30-day mortality.

Results: Among 678 patients, 40.4% (274/678) had potential ICU treatment needs. Overall, 92.6% had organ failure, and 41.3% had multiple organ dysfunctions. IMCU management avoided ICU admission in 203 of 274 patients (79.9%). ICU transfer rate was 6.9% (47/678), and 30-day mortality was 12.8% (87/678). Among ICU-potential patients, mortality was 16.4% (45/274), decreasing to 11.4% (27/236) in those without ICU exclusion criteria.

Conclusions: These findings suggest that IMCUs may serve as an effective alternative for managing critically ill non-intensive care patients, reducing avoidable ICU admissions while maintaining clinical outcomes.

查看原文本刊更多论文

中级监护病房：减少重症监护病房入院的有效选择——一项前瞻性队列研究。

背景：来自急诊科（ED）的危重病人要么住在普通病房，要么住在重症监护病房（ICU）。这种二元分配可能导致非重症重症患者的管理不理想，增加ICU过度拥挤。中级护理病房（imcu）可能是一个有效的替代方案，但其减少可避免的ICU入院的能力尚不清楚。目的：评价IMCU是否能有效管理有潜在ICU治疗需求的急症患者，并评估其在减少可避免的ICU入院和维持患者预后方面的作用。方法：这项前瞻性观察性研究（2024年1月至12月）在意大利圣托索Alto Vicentino医院IMCU进行。包括所有入住IMCU的急性患者，不包括逐步转入ICU的患者。记录临床特征、疾病严重程度和器官功能障碍。患者根据其潜在的ICU治疗需求进行分类，并记录了ICU排除标准。主要结局是由于IMCU失效而转入ICU和30天死亡率。结果：678例患者中，40.4%（274/678）有潜在的ICU治疗需求。总体而言，92.6%有器官衰竭，41.3%有多器官功能障碍。IMCU管理使274例患者中203例（79.9%）避免住院。ICU转院率为6.9%(47/678)，30天死亡率为12.8%（87/678）。在有ICU排除标准的患者中，死亡率为16.4%(45/274)，而在没有ICU排除标准的患者中，死亡率为11.4%（27/236）。结论：这些研究结果表明，imcu可以作为管理危重非重症患者的有效选择，在保持临床结果的同时减少可避免的ICU入院。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Internal and Emergency Medicine 医学-医学：内科

CiteScore

7.20

自引率

4.30%

发文量

258

审稿时长

6-12 weeks

期刊介绍： Internal and Emergency Medicine (IEM) is an independent, international, English-language, peer-reviewed journal designed for internists and emergency physicians. IEM publishes a variety of manuscript types including Original investigations, Review articles, Letters to the Editor, Editorials and Commentaries. Occasionally IEM accepts unsolicited Reviews, Commentaries or Editorials. The journal is divided into three sections, i.e., Internal Medicine, Emergency Medicine and Clinical Evidence and Health Technology Assessment, with three separate editorial boards. In the Internal Medicine section, invited Case records and Physical examinations, devoted to underlining the role of a clinical approach in selected clinical cases, are also published. The Emergency Medicine section will include a Morbidity and Mortality Report and an Airway Forum concerning the management of difficult airway problems. As far as Critical Care is becoming an integral part of Emergency Medicine, a new sub-section will report the literature that concerns the interface not only for the care of the critical patient in the Emergency Department, but also in the Intensive Care Unit. Finally, in the Clinical Evidence and Health Technology Assessment section brief discussions of topics of evidence-based medicine (Cochrane’s corner) and Research updates are published. IEM encourages letters of rebuttal and criticism of published articles. Topics of interest include all subjects that relate to the science and practice of Internal and Emergency Medicine.