PLANNING PATIENT SERVICES FOR INTERMEDIATE CARE UNITS - INSIGHTS BASED ON CARE FOR INTENSIVE-CARE UNIT LOW-RISK MONITOR ADMISSIONS

Objective: To describe the technology and nursing services that would be required to care for intensive care unit (ICU) low-risk monitor adm issions in an intermediate unit. Design: Prospective, multicenter, inc eption cohort analysis. Setting: Forty U.S. hospitals with >200 beds, including 26 hospitals that were randomly selected and 14 that volunte ered for the study. Patients: A sample of 8,040 ICU patients admitted to the ICU for monitoring, who received no active life support treatme nt on ICU day 1. Interventions: None. Measurements and Main Results: D emographic, physiologic, and treatment information were obtained durin g ICU days 1 to 7, A previously validated multivariate equation was us ed to identify 6,180 monitor admissions at low (<10%) risk for receivi ng active treatment during their entire ICU stay, We used daily Therap eutic Intervention Scoring System (TISS) data to identify the equipmen t, 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 i ntermediate 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 a dmissions, 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 poi nts per patient per day, Medical admissions had a 2.7-day mean ICU len gth of stay and received an average of 12.3 TISS points per patient pe r day. Subsequent active life-support therapy was received by 4.4% of these ICU low-risk monitor admissions. Conclusions: The services recei ved by ICU low risk monitor admissions provide insight regarding the e quipment and nursing care that might be required, and the kinds of eme rgencies that might occur, if these patients were cared for in medical and surgical intermediate care units, Our data suggest that if ICU lo w-risk monitor patients were admitted to an intermediate care unit, th ey would mainly require concentrated nursing care (nurse/patient ratio of 1:3 to 1:4) and limited technologic monitoring.