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 post-inclusion, 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. IMCU-admission 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.