Category Archives: Care

Closure of an Intermediate Care Unit: Finally

Admission and discharge decision-making regarding “low-risk” monitored admissions will depend on what alternatives are available outside the CCU. Closure of the ICA reduced flexibility in discharging patients and thus, the capacity to adjust discharge decision-making was lost. This lost flexibility resulted in no change in mean CCU length of stay, in spite of the increased number of “low-risk” admissions with low APACHE II scores; these … Continue reading

Closure of an Intermediate Care Unit: Conclusion

We cannot comment on the cost-effectiveness to the hospital of the decision to close the ICA because we do not have accurate cost per patient data and because the case-mix distribution clearly changed. The patient population served by the ICA was admitted to either the wards or to the CCU in the post-ICA closure period. After ICA closure, we found an increased proportion of CCU … Continue reading

Closure of an Intermediate Care Unit: Discussion

When hospital structure and organization change, the utilization of key service components, such as critical care, also changes. The high costs of critical care and the limited access to these services necessitates an organized approach to resource management during periods of adjustment. Reports of CCU utilization often study altered patterns of use when a “step-down unit” or ICA is opened. Our data demonstrated the extent … Continue reading

Closure of an Intermediate Care Unit: Results

Table 1 summarizes demographic and admission data for patients admitted during both 9-month data collection periods. The number of CCU admissions increased from 217 to 407 with closure of the ICA and expansion of the CCU from 7 to 9 beds. The increased throughput in CCU was from 31 patients per CCU bed per 9 months to 45.2 patients per CCU bed per 9 months. … Continue reading

Closure of an Intermediate Care Unit: Data Collected

During both data collection periods, CCU admission and discharge were determined by the same critical care team. The total number of hospital beds available was reduced from a daily average of503 beds (range, 354 to 560) in the pre-ICA closure period to 467 (range, 348 to 497) after ICA closure. The cause of the reduced number of beds and reorganization of critical care facilities was … Continue reading

Closure of an Intermediate Care Unit

The high cost of providing critical care has provoked a variety of “utilization strategies” within hospitals to optimize use of these scarce resources. The relative scarcity of critical care resources and limited access to them is a result of both increasing demand and restrained supply. One strategy that many hospitals have adopted is the provision of “graded” levels of care in intermediate care units to … Continue reading