title: The effects of discharge to an intermediate care unit after a critical illness: a 5-year cohort study.
abstract: OBJECTIVE
  The impact of the intermediate care unit (IMCU) on post-intensive care unit (ICU) outcomes is controversial.
  
  
  METHODS
  We analyzed admissions from January 2003 to December 2008 from a mixed ICU in a teaching hospital in Brazil with a high patient-to-nurse ratio (3.5:1 on the ICU, 11:1 on the IMCU, 20-25:1 on the ward). A retrospective propensity-matched analysis was performed with data from 690 patients who were discharged after at least 3 days of ICU stay.
  
  
  RESULTS
  Of the 690 patients, 160 (23%) were discharged to the IMCU. A total of 399 propensity-matched patients were compared: 298 were discharged to the ward and 101 were discharged to the IMCU. Ninety-day mortality rate was similar between the IMCU and ward patients (22% vs 18%, respectively, P = .37), as was the unplanned ICU readmission rate (P = .63). In a multivariate logistic regression, discharge to the IMCU had no effect on the 90-day mortality rate (P = .27).
  
  
  CONCLUSIONS
  In a resource-limited setting with a high patient-to-nurse ratio, discharge to IMCU had no impact on 90-day mortality rate and on unplanned readmission rate. The impact of discharge to the IMCU on the outcome for critically ill patients should be evaluated in further studies.
authors.affiliation: Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil. Electronic address: otavioranzani@yahoo.com.br.
authors.forename: Otavio T
authors.initials: OT
authors.lastname: Ranzani
authors.affiliation: Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil; Intensive Care Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.
authors.forename: Fernando Godinho
authors.initials: FG
authors.lastname: Zampieri
authors.affiliation: Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil; Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Leandro Utino
authors.initials: LU
authors.lastname: Taniguchi
authors.affiliation: Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil; Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Daniel Neves
authors.initials: DN
authors.lastname: Forte
authors.affiliation: Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil; Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Luciano César Pontes
authors.initials: LC
authors.lastname: Azevedo
authors.affiliation: Intensive Care Unit, Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil; Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Park
mesh_terms: D000368:Aged; D001938:Brazil; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D010351:Patient Discharge; D057216:Propensity Score; D012189:Retrospective Studies; D000078329:Workforce
keywords: Critical care; Discharge planning; Long-term survivors; Patient discharge; Wards