title: Outcomes of Emergency Medical Patients Admitted to an Intermediate Care Unit With Detailed Admission Guidelines.
abstract: An important, but not well characterized, population receiving intermediate care is that of medical patients admitted directly from the emergency department.
  
  
  
  To characterize emergency medical patients and their outcomes when admitted to an intermediate care unit with clearly defined admission guidelines.
  
  
  
  Demographic data, admitting diagnoses, illness severity, comorbid conditions, lengths of stay, and hospital mortality were characterized for all emergency medical patients admitted directly to an intermediate care unit from July through December 2012.
  
  
  
  A total of 317 unique patients were admitted (mean age, 54 [SD, 16] years). Most patients were admitted with respiratory (26.5%) or cardiac (17.0%) syndromes. The mean (SD) Acute Physiology and Chronic Health Evaluation score version II, Simplified Acute Physiology Score version II, and Charlson Comorbidity Index were 15.6 (6.5), 20.7 (11.8), and 2.7 (2.3), respectively. Severity of illness and length of stay were significantly different for patients who required intensive care within 24 hours of admission (n = 16) or later (n = 25), patients who continued with inter mediate care for more than 24 hours (n = 247), and patients who were downgraded or discharged in less than 24 hours (n = 29). Overall hospital mortality was 4.4% (14 deaths).
  
  
  
  Emergency medical patients with moderate severity of illness and comorbidity can be admitted to an intermediate level of care with relatively infrequent transfer to intensive care and relatively low mortality.
authors.affiliation: Catherine E. Simpson and Sarina K. Sahetya are fellows, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland. Robert W. Bradsher III is an instructor, Division of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee. Eric L. Scholten is a fellow, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Diego, California. William Bain is a fellow, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Shazia M. Siddique is a fellow, Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. David N. Hager is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Simpson
authors.affiliation: Catherine E. Simpson and Sarina K. Sahetya are fellows, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland. Robert W. Bradsher III is an instructor, Division of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee. Eric L. Scholten is a fellow, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Diego, California. William Bain is a fellow, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Shazia M. Siddique is a fellow, Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. David N. Hager is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University.
authors.forename: Sarina K
authors.initials: SK
authors.lastname: Sahetya
authors.affiliation: Catherine E. Simpson and Sarina K. Sahetya are fellows, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland. Robert W. Bradsher III is an instructor, Division of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee. Eric L. Scholten is a fellow, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Diego, California. William Bain is a fellow, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Shazia M. Siddique is a fellow, Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. David N. Hager is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Bradsher
authors.affiliation: Catherine E. Simpson and Sarina K. Sahetya are fellows, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland. Robert W. Bradsher III is an instructor, Division of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee. Eric L. Scholten is a fellow, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Diego, California. William Bain is a fellow, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Shazia M. Siddique is a fellow, Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. David N. Hager is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Scholten
authors.affiliation: Catherine E. Simpson and Sarina K. Sahetya are fellows, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland. Robert W. Bradsher III is an instructor, Division of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee. Eric L. Scholten is a fellow, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Diego, California. William Bain is a fellow, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Shazia M. Siddique is a fellow, Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. David N. Hager is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University.
authors.forename: William
authors.initials: W
authors.lastname: Bain
authors.affiliation: Catherine E. Simpson and Sarina K. Sahetya are fellows, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland. Robert W. Bradsher III is an instructor, Division of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee. Eric L. Scholten is a fellow, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Diego, California. William Bain is a fellow, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. Shazia M. Siddique is a fellow, Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. David N. Hager is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University.
authors.forename: Shazia M
authors.initials: SM
authors.lastname: Siddique
authors.affiliation: David N. Hager is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University. David N. Hager, MD, PhD, Johns Hopkins University, Sheikh Zayed Tower, Ste 9121, 1800 Orleans St, Baltimore, MD 21287 (e-mail: dhager1@jhmi.edu).
authors.forename: David N
authors.initials: DN
authors.lastname: Hager
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003422:Critical Care; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007380:Intermediate Care Facilities / Q000592:standards*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards*; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D016896:Treatment Outcome