title: Introducing an integrated intermediate care unit improves ICU utilization: a prospective intervention study.
abstract: BACKGROUND
  Improvement of appropriate bed use and access to intensive care (ICU) beds is essential in optimizing utilization of ICU capacity. The introduction of an intermediate care unit (IMC) integrated in the ICU care may improve this utilization.
  
  
  METHODS
  In a before-after prospective intervention study in a university hospital mixed ICU, the impact of introducing a six-bed mixed IMC unit supervised and staffed by ICU physicians was investigated. Changes in ICU utilization (length of stay, frequency of mechanical ventilation use), nursing workload assessed byTISS-28 score, as well as inappropriate bed use, accessibility of the ICU (number of referrals), and clinical outcome indicators (readmission and mortality rates) were measured.
  
  
  RESULTS
  During 17 months, data of 1027 ICU patients were collected. ICU utilization improved significantly with an increased appropriate use of ICU beds. However, the number of referrals, readmissions to the ICU and mortality rates did not decrease after the IMC was opened.
  
  
  CONCLUSIONS
  The IMC contributed to a more appropriate use of ICU facilities and did result in a significant increase in mean nursing workload at the ICU.
authors.affiliation: Staff department of Quality and Safety, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, HX 6229, The Netherlands.
authors.forename: Barbara C J
authors.initials: BC
authors.lastname: Solberg
authors.affiliation: Clinical Epidemiology & Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Dirksen
authors.affiliation: Clinical Epidemiology & Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Fred H M
authors.initials: FH
authors.lastname: Nieman
authors.affiliation: Department of Health Organisation, Policy and Economics (BEOZ), University of Maastricht, P.O. Box 616, Maastricht, MD 6200, The Netherlands.
authors.forename: Godefridus
authors.initials: G
authors.lastname: van Merode
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands ; Regent House, Mittre Way, Battle, East Sussex, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Ramsay
authors.affiliation: Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Roekaerts
authors.affiliation: Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands ; Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Poeze
mesh_terms: D000328:Adult; D000368:Aged; D017598:Efficiency, Organizational; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data; D007380:Intermediate Care Facilities / Q000458:organization & administration*; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009726:Nurses; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D016896:Treatment Outcome; D016526:Workload
keywords: Efficiency; Hospital bed capacity; Intensive care; Intermediate care; Resource allocation