Planning patient services for intermediate care units: insights based on care for intensive care unit low-risk monitor admissions

J E Zimmerman, D P Wagner, X Sun, W A Knaus, E A Draper
Critical Care Medicine 1996, 24 (10): 1626-32

OBJECTIVE: To describe the technology and nursing services that would be required to care for intensive care unit (ICU) low-risk monitor admissions in an intermediate unit.

DESIGN: Prospective, multicenter, inception cohort analysis.

SETTING: Forty U.S. hospitals with > 200 beds, including 26 hospitals that were randomly selected and 14 that volunteered for the study.

PATIENTS: A sample of 8,040 ICU patients admitted to the ICU for monitoring, who received no active life-support treatment on ICU day 1.


MEASUREMENTS AND MAIN RESULTS: Demographic, physiologic, and treatment information were obtained during ICU days 1 to 7. A previously validated multivariate equation was used to identify 6,180 monitor admissions at low (< 10%) risk for receiving active treatment during their entire ICU stay. We used daily Therapeutic intervention Scoring System (TISS) data to identify the equipment, type and amount of nursing care, and the types of active treatment that would have been used had these ICU patients been admitted to an intermediate care unit. Mean day-1 ICU TISS scores were as follows: 16.4 for all patients; 18.3 for surgical patients; and 13.5 for medical admissions. Concentrated nursing care accounted for 89% and technologic monitoring for 11% of day-1 TISS points. Surgical admissions had a 2.8-day mean ICU length of stay and received an average of 16.5 TISS points per patient per day. Medical admissions had a 2.7-day mean ICU length of stay and received an average of 12.3 TISS points per patient per day. Subsequent active life-support therapy was received by 4.4% of these ICU low-risk monitor admissions.

CONCLUSIONS: The services received by ICU low-risk monitor admissions provide insight regarding the equipment and nursing care that might be required, and the kinds of emergencies that might occur, if these patients were cared for in medical and surgical intermediate care units. Our data suggest that if ICU low-risk monitor patients were admitted to an intermediate care unit, they would mainly require concentrated nursing care (nurse/patient ratio of 1:3 to 1:4) and limited technologic monitoring.

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