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 patients stayed only 1 or 2 days. Medical suitability remains the basis for CCU admission and discharge decision-making. Little attention has been paid to establishing priorities for discharge, although physicians do this daily.
In this study, important changes in CCU utilization occurred without any significant differences in overall CCU length of stay. This happened because the effect of an increased number of short-stay patients with low APACHE and TISS scores was offset by the necessity of keeping “sicker” patients longer in the CCU because of the lack of stepdown facilities to discharge them to. Similarly, the reduction in calculated mortality rate for patients staying in the CCU only 1 or 2 days probably does not reflect a change in the quality of care provided because the severity of illness and preadmission chronic health disability decreased. Thus, the CCU length of stay and mortality rates, taken in isolation, are not sufficient measures of CCU utilization, especially during times of administrative change. canadian pharmacy mall

In conclusion, we found that the structure and availability of non-CCU facilities, such as the ICA, to a significant extent determined the utilization of a critical care facility. Our data emphasize the need to take a “system” approach to utilization analysis in critical care. Utilization analysis must therefore consider both the need for CCU and the facilities available in the CCU, as well as in the hospital and the health care system. These facilities vary with time and place and must be defined in order to properly interpret CCU utilization data. The need for a continuous audit of CCU utilization is most marked when organizational strategies are changing. The result of our analysis was the reestablishment of a unit (ICA) to provide specified monitoring (ECG and pulse oximetry) to “low-risk” monitored patients in a less intensively staffed area. As well, the need for a CCU audit became the focus of a utilization management system with an emphasis on nursing workload assessment and severity of illness. It is only by taking advantage of these “natural experiments” which occur in all organizations that we will be able to study factors that determine the proper allocation and utilization of critical care resources.

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