Article Text
Abstract
Background The management format of the mixed-surgical intermediate care unit (IMCU) affects its performance. A format of combined supervision of surgeons with additional critical care certifications and admitting specialists, named the “joint format”, may herein be a promising new model of specialized critical care. This study aims to assess the performance of the joint management format.
Methods This observational cohort study compared three IMCU management formats at the stand-alone, mixed-surgical IMCU of a tertiary referral hospital using interrupted time series analyses. All admissions from 2001 until 2015 were included. Predetermined criteria for performance (utilization, efficiency, and safety) were applied to three different management format periods: open (2001–2006), closed (2006–2011), and joint (2011–2015) formats.
Results A total of 8894 admissions were analyzed. In terms of case load (utilization), there was an overall increase in the number of surgical patients (0.25%/year) (p<0.001), age (0.38/year) (p<0.001), and readmissions from the ward (0.16%/year) (p<0.001) and from the intensive care unit (ICU) (0.17%/year) (p=0.014). In terms of efficiency, the admission duration decreased (1.58 hours/year) (p<0.001). Transfer to the ICU within 24 hours, readmission within 24 hours from the ward, and unplanned mortality (eg, safety) did not change over time.
Discussion At a time of increasingly complex case load, the joint format at the mixed-surgical IMCU is an efficient and safe management format in which the admitting specialist continues to provide specialized care. Specialty-specific supervision at IMCUs is a safe option which should be considered in healthcare policy decisions.
Level of evidence Level IV.
- critical care organization
- high dependency unit
- intermediate care unit
- management format
- surgical critical care
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Footnotes
Contributors JDJP made substantial contributions to design, data collection, data analysis and the interpretation of the results. JDJP was the main author involved in drafting and finalizing the article. LMP made substantial contributions to the data analysis and interpretation and critically revised the article. LPHL was involved in the design and critically revised the article. RMH made substantial contributions to conception and design and critically revised the article. FH contributed to the design and actively participated in data collection, analysis and its interpretation. He was involved in drafting the article and revising it critically. JDJP, LMP, LPHL, RMH and FH have all given final approval of the version to be published.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Ethics approval According to the Institutional Review Board of the University Medical Center Utrecht, the study was not subject to the Medical Research Involving Human Subjects Act and therefore the necessity of informed consent was waived (protocol number 17-326/C).
Provenance and peer review Not commissioned; externally peer reviewed.