title: Results of a retrospective observational study of intermediate care staffed by hospitalists: impact on mortality, co-management, and teaching.
abstract: BACKGROUND
  Hospitalized patients are complex and institutions have to face the high cost of critical care and the limited resources of the ward. Intermediate care appears as an attractive strategy to provide rational care according to patient needs. It is an interesting scenario to expand co-management and teaching.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Intermediate care unit (ImCU) of a single academic hospital.
  
  
  METHODS
  456 patients admitted from April 2006 to April 2010 were included in the study. Demographics, admission physiologic parameters and in-hospital mortality were recorded. We used the Simplified Acute Physiology Score II (SAPS II) as prognostic score system. Co-management with medical and surgical teams, and the number of training residents were evaluated.
  
  
  RESULTS
  In-hospital mortality was 20.6%, whereas the expected mortality was 23.2% based on SAPS II score. The correlation between SAPS II predicted and observed death rates was accurate and statistically significant (Rho = 1.0, p < 0.001). Co-management was performed with several medical and surgical teams, with an increase in perioperative comanagement of 22.7% (p = 0.014). The number of training residents in ImCU increased from 4.3% to 30.4% (p = 0.002)
  
  
  CONCLUSIONS
  An ImCU led by hospitalists showed encouraging results regarding patient survival and SAPS II is an useful tool for prognostic evaluation in this population. Intermediate care serves as an expansion of role for hospitalists; and clinicians, trainees and patients may benefit from co-management and teaching opportunities at this unique level of care.
authors.affiliation: Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clínica Universidad de Navarra, Pamplona, Spain. flucena@unav.es
authors.forename: Juan Felipe
authors.initials: JF
authors.lastname: Lucena
authors.forename: Félix
authors.initials: F
authors.lastname: Alegre
authors.forename: Raquel
authors.initials: R
authors.lastname: Rodil
authors.forename: Manuel Fortún
authors.initials: MF
authors.lastname: Landecho
authors.forename: Alberto
authors.initials: A
authors.lastname: García-Mouriz
authors.forename: Margarita
authors.initials: M
authors.lastname: Marqués
authors.forename: Irene
authors.initials: I
authors.lastname: Aquerreta
authors.forename: Nicolás
authors.initials: N
authors.lastname: García
authors.forename: Jorge
authors.initials: J
authors.lastname: Quiroga
mesh_terms: D000368:Aged; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D020445:Hospitalists / Q000379:methods* / Q000639:trends; D006801:Humans; D007380:Intermediate Care Facilities / Q000379:methods* / Q000639:trends; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods* / Q000639:trends; D010561:Personnel Staffing and Scheduling / Q000639:trends; D012189:Retrospective Studies