Severity‐stratified outcomes of acutely ill medical patients in an intermediate care unit: a prospective cohort study

BACKGROUND: Intermediate medical care units (IMCUs), positioned between general medical wards and intensive care units (ICUs), have seen increasing implementation in recent years. However, evidence regarding clinical outcomes in high-acuity patients remains limited. AIM: To describe outcomes of critically ill medical patients managed in an IMCU, stratified by severity and the number of organ failures and to compare these outcomes with those historically reported for similar populations treated in ICUs. METHODS: Through a prospective cohort of patients consecutively admitted to an IMCU between January and December 2024, patients were stratified according to the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the number of organ failures at admission. The primary outcome was 72-h and 30-day mortality. A subpopulation potentially eligible for ICU care was also identified based on high APACHE II scores and/or the presence of multiple organ failures. RESULTS: A total of 678 patients were included. Of these, 30.7% met criteria for high clinical complexity (APACHE II >20 and/or three or more organ failures). The overall 30-day mortality was 13.7%. Specifically, mortality was 14.2% among patients with APACHE II scores between 10 and 20, and 31.5% in those with APACHE II >20. In the high-acuity subgroup (n = 208), the 30-day mortality was 24.5%. The outcomes observed were consistent with those reported in the literature for patients with similar clinical profiles managed in ICUs. CONCLUSION: This study shows real-world outcomes of managing acutely ill medical patients in an IMCU, aligning with ICU results and supporting IMCUs as a safe, effective bridge between general and intensive care.