title: Opening of a respiratory intermediate care unit in a general hospital: impact on mortality and other outcomes.
abstract: BACKGROUND
  Respiratory intermediate care units (RICUs) are specialized areas aimed at optimizing the cost-benefit ratio of care. No data exist about the impact of opening a RICU on hospital outcomes.
  
  
  OBJECTIVE
  We wondered if opening a RICU may improve the outcomes of patients with acute respiratory failure (ARF), acute exacerbation of chronic obstructive pulmonary disease (AECOPD), or community-acquired pneumonia (CAP).
  
  
  METHODS
  We analyzed the discharge abstracts of 2,372 admissions to the RICU and internal medicine units (IMUs) for ARF, AECOPD, and CAP. The IMUs at the Hospital of Trieste comprise emergency and internal wards. In order to investigate the determinants of outcomes, a matched case-control study was performed using clinical records.
  
  
  RESULTS
  The in-hospital mortality rate was lower in the RICU vs. IMUs (5.4 vs. 19.1%, p = 0.0001). Statistical differences did not change when comparing the RICU with the emergency and internal wards. After adjusting for potential confounders, the risk of death for patients with CAP, AECOPD, or ARF was significantly higher in the IMUs than in the RICU (OR 6.90, 3.19, and 6.7, respectively, p < 0.04). Both the frequency of transfer to the ICU (6 vs. 12%, p = 0.0001, OR 0.38) and the hospital stay (9.3 vs. 12.1 days, p = 0.0001) were reduced in patients admitted to the RICU compared to those admitted to non-RICUs. Significant differences were found in care management concerning chest physiotherapy, mechanical ventilation, antibiotics, and corticosteroids.
  
  
  CONCLUSIONS
  The opening of a RICU may be advantageous to reduce in-hospital mortality, the need for ICU admission, and the hospital stay of patients with AECOPD, CAP, and ARF. Better use of care resources contributed to better patient management in the RICU.
authors.affiliation: Department of Pneumology and Respiratory Intermediate Care Unit, University Hospital of Cattinara, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Confalonieri
authors.forename: Roberto
authors.initials: R
authors.lastname: Trevisan
authors.forename: Maja
authors.initials: M
authors.lastname: Demsar
authors.forename: Luca
authors.initials: L
authors.lastname: Lattuada
authors.forename: Cinzia
authors.initials: C
authors.lastname: Longo
authors.forename: Rossella
authors.initials: R
authors.lastname: Cifaldi
authors.forename: Mitja
authors.initials: M
authors.lastname: Jevnikar
authors.forename: Mario
authors.initials: M
authors.lastname: Santagiuliana
authors.forename: Lucia
authors.initials: L
authors.lastname: Pelusi
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pistelli
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002423:Cause of Death; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D016001:Confidence Intervals; D005260:Female; D005602:France; D017052:Hospital Mortality; D006769:Hospitals, General; D006801:Humans; D007380:Intermediate Care Facilities / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011014:Pneumonia / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome