THE INTERMEDIATE CARE UNIT AS A COST-EFFECTIVE OPTION FOR THE TREATMENT OF MEDICAL PATIENTS IN CRITICAL CONDITION

Since the limited accessibility of general intensive care units create s a situation in which medical patients in critical condition continue to be cared for in the regular wards, we conducted a retrospective co hort study to assess the treatment outcomes in such patients referred to the medical intermediate care unit (MICU). At the Soroka Medical Ce nter, a facility with 810 beds, of which 170 beds are in medical wards , including an 8-bed intensive cardiac care unit and a 5-bed general i ntensive care unit, 119 patients were referred to the MICU, directly f rom the emergency room or from medical wards, during the first half of 1994. Eighty percent of the patients were admitted to the MICU direct ly from the emergency room. The mean disease severity, as measured by the APACHE II score, Was 12.9, and the mean intensity of care for thes e patients, as measured by the TISS scale, was 12.6. Twenty-one of the 119 patients died during hospitalization (17.6%). This mortality rate conformed to the mortality risk of 15.5%, which was calculated using prognostic formulae. The ratio of nursing staff to patient in the MICU was approximately 1:3, compared to 2:3 in the general intensive care unit and 1:12 in the wards. The mean cost of one day of hospitalizatio n in the MICU was one-third that in the general intensive care unit an d double the cost in a ward. Medical patients in critical condition ca n be treated in an MICU, with a savings in expenses and without impair ing the patient's chances for survival.