Intensive care unit utilization following the elimination of intermediate care

BACKGROUND: Many hospitals have established intermediate care units (IMCU) to improve intensive care unit (ICU) utilization. There is little data on how eliminating an existing IMCU affects ICU utilization and the characteristics of ICU patients. OBJECTIVE: Effect of IMCU elimination on ICU utilization and characteristics of patients admitted to the ICU. METHODS: Retrospective observational before-after study. ICU utilization and characteristics of patients admitted to the ICU were evaluated. RESULTS: Following IMCU elimination ICU utilization significantly increased. ICU admissions increased from 14.2% to 20.5% of hospital admissions, p < .001, monthly ICU admissions increased 42% while total ICU and hospital days increased 32% and 30%, respectively. Pre-elimination IMCU to ICU transfers comprised 6.7% of ICU admissions. Post elimination emergency department (ED) to ICU admissions increased (31.0% vs. 23.6%) as did ward to ICU admissions (41.3% vs. 37.6%). Low-risk monitoring ICU admissions increased 23% to 33%. There was no increase in ICU readmissions or time from ED to ICU or hospital admission. For ICU patients, propensity-adjusted odds ratio (OR) indicated lower ICU and hospital mortality following IMCU elimination, OR 0.82 (0.71, 0.96) and OR 0.83 (0.73, 0.95), respectively. Interrupted Time Series analysis demonstrated that IMCU elimination did not significantly affect secular trends in ICU or hospital mortality. CONCLUSION: Eliminating IMCU increased ICU utilization and affected the characteristics of ICU admissions. Despite increased utilization, the outcomes of patients admitted to the ICU did not worsen. Further study is warranted on the clinical outcomes of patients previously admitted to IMCU and hospital outcomes following IMCU elimination.