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 an institutional (operating) deficit of $62 million.
Information collected on every admission to the medical-surgical CCU included the following: age, sex, primary service referring the patient, and type of hospital admission (emergency, nonemergency). As well, the CCU length of stay, hospital length of stay, and survival were noted.
The severity of illness during the first 24 h in the CCU was assessed using the APACHE II scoring system. This methodology scores, on a scale of 0 to 4, each of 12 physiologic variables commonly measured in critically ill patients. The APACHE II score is composed of the weighted value of these physiologic variables (score increases based on the deviation from normal values during the 24 h after admission) plus points for age and chronic health status. Specific consideration was given to standardization of values for the Glasgow Coma Score, included as one of the 12 physiologic variables. Since many postoperative surgical patients were anesthetized and partially paralyzed on admission to the CCU, the Glasgow Coma Score was recorded as normal if a postoperative patient was awake and following commands within 24 h of admission.
The nursing workload and interventions used during the first 24 h in the CCU were assessed using the Therapeutic Intervention Scoring System (TISS) which weights critical care nursing interventions (one to four points per intervention) based on complexity of expertise required. A “modified TISS** scored at the time of discharge from the CCU was also recorded as a “one-time” measurement of nursing interventions ordered for each patient, not the cumulative 24-h score for admission TISS. The purpose of recording the interventions (modified TISS) required for patient care on leaving the CCU was to estimate the nursing care required after discharge.
Routine data collection by nursing staff was integrated into a CCU audit system. A relational database management system (dBase IV, Borland, Scotts Valley, Calif) was used to develop the management program (Carebase) for entering, maintaining, and analyzing collected data. A trained health records technician was responsible for reviewing each chart and entering data. The accuracy of data for nondiagnosis-related fields, such as length of stay, have been verified on chart reabstraction to have match rates greater than 95 percent.
Statistical Analysis
Data are reported as mean ± standard deviation. Continuous variables were compared using analysis of variance for parametric data and the Kolmogorov-Smimov test for nonparametric data (eg, length of stay). A statistical package (SAS, Statistical Analysis System) was used for the analysis. Frequency data were examined using the x* where appropriate. Differences were considered significant when the p value was <0.05.

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