NEUROLOGICAL INTENSIVE-CARE ADMISSIONS - IDENTIFYING CANDIDATES FOR INTERMEDIATE CARE AND THE SERVICES THEY RECEIVE

OBJECTIVE: The high cost and scarcity of intensive care unit (ICU) bed s has resulted in a need for improved utilization. This study describe s the characteristics of patients who are admitted to the ICU for neur osurgical and neurological care, identifies patients who might receive all or most of their care in an intermediate care unit, and describes the services the patients would receive in an intermediate cave unit. METHODS: We describe patients who received neurological care and who were part of a prospective study of 17,440 patients admitted to 42 ICU s at 40 United States hospitals. We identified patients who received o nly monitoring during ICU Day 1 and then used a previously validated e quation to distinguish which patients were at low risk (<10%) for subs equent active life-supporting therapy. We also describe the services t hese patients received during their ICU stay. RESULTS: Among 3000 pati ents admitted to the ICU for neurological care, 1350 received active t herapy and 1650 (55%) underwent monitoring and received concentrated n ursing care on ICU Day 1. After excluding those patients who received active therapy at admission, 1288 (78%) of the 1650 patients who under went monitoring at admission were at low risk (<10%) for subsequent ac tive therapy; 95.8% received no active therapy. These patients who wer e at low risk for subsequent active therapy were significantly (P < 0. 001) more often admitted postoperatively, were younger and less severe ly ill, and had lower ICU and hospital mortality rates (0.9 and 3.9%, respectively) than patients who received active treatment at admission . CONCLUSIONS: Patients receiving neurological care at an ICU who rece ive only monitoring during their Ist ICU day and have a less than 10% predicted risk of active treatment can be safely transferred to an int ermediate care unit. Some of these patients may not require ICU admiss ion. We suggest guidelines for equipping and staffing neurological int ermediate care units based on the type and amount of therapy received by these patients.