title: Use of flexible intermediate and intensive care to reduce multiple transfers of patients.
abstract: OBJECTIVE
  To test an alternative flexible approach to traditional fixed intermediate and intensive care to minimize transfers of patients.
  
  
  METHODS
  Patients admitted to a 28-bed nursing unit with intermediate care potential and a 12-bed intensive care unit at a 300-bed teaching community hospital were studied. The group included 524 patients with a discharge diagnosis code for mechanical ventilation. During eight 3-week cycles, 1073 transfers of patients were tabulated. A plan-do-study-act method was used to improve weaning from mechanical ventilation and reduce the number of inappropriate days in intensive care. Admissions and transfers to the 2 units for all patients during the eight 3-week cycles were compared over time. Length of stay and mortality were noted for all patients treated with conventional and noninvasive ventilation.
  
  
  RESULTS
  Direct admissions to the flexible intermediate unit increased with no overall change in admissions to the intensive care unit. Fewer patients needed conventional ventilation, and more in both units were treated with noninvasive ventilation. The median number of transfers per patient treated with mechanical ventilation decreased from 1.94 to 1.20. Length of stay and mortality also decreased among such patients. Some cost savings were attributable to the decrease in the number of transfers. Transfers out of the hospital directly from the intensive care unit increased from 2.24% to 4.43%.
  
  
  CONCLUSIONS
  In a community teaching hospital, flexible care policies decreased the number of in-hospital transfers of patients treated with mechanical ventilation.
authors.affiliation: Department of Critical Care, Muhlenberg Regional Medical Center, Plainfield, NJ, USA.
authors.forename: E
authors.initials: E
authors.lastname: Besserman
authors.forename: D
authors.initials: D
authors.lastname: Teres
authors.forename: A
authors.initials: A
authors.lastname: Logan
authors.forename: M
authors.initials: M
authors.lastname: Brennan
authors.forename: S
authors.initials: S
authors.lastname: Cleaves
authors.forename: R
authors.initials: R
authors.lastname: Bayly
authors.forename: D
authors.initials: D
authors.lastname: Brochis
authors.forename: B
authors.initials: B
authors.lastname: Nemeth
authors.forename: J
authors.initials: J
authors.lastname: Grare
authors.forename: D
authors.initials: D
authors.lastname: Ngo
mesh_terms: D003422:Critical Care / Q000379:methods / Q000458:organization & administration*; D017052:Hospital Mortality; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D010360:Patient Transfer; D012121:Respiration, Artificial; D014481:United States