Analysis of admissions to intensive care units that could be supported on an intermediate care unit

Jérôme Tack; Arnaud Bruyneel; Fabio Taccone; Fréderic Thys; Christian Mélot; Phillipe Van Wilder; Magali Pirson

doi:10.1111/nicc.13043

Analysis of admissions to intensive care units that could be supported on an intermediate care unit

Nurs Crit Care. 2024 Feb 13. doi: 10.1111/nicc.13043. Online ahead of print.

Authors

Jérôme Tack^{1

2}, Arnaud Bruyneel¹, Fabio Taccone³, Fréderic Thys^{2

4

5}, Christian Mélot¹, Phillipe Van Wilder⁶, Magali Pirson¹

Affiliations

¹ Research Center in Health Economics, Management of Health Care Institutions and Nursing Sciences, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
² Clinical Research and Translational Unit, Grand Hôpital de Charleroi (GHdC), Charleroi, Belgium.
³ Soins intensifs - Hôpitaux Universitaire Bruxellois - Hôpital Erasme, Anderlecht, Belgium.
⁴ Continuing Education Unit UCLouvain Woluwe, Université Catholique de Louvain, Woluwe-Saint-Lambert, France.
⁵ Department of Acute and Emergency Medicine, Grand Hôpital de Charleroi (GHdC), Charleroi, Belgium.
⁶ Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Brussels, Belgium.

PMID: 38351617
DOI: 10.1111/nicc.13043

Abstract

Background: Only one third of European countries use intermediate care units (IMCs). An IMC makes it possible to manage patients who do not require intensive care but who need a higher level of nursing care that cannot be provided on the general ward. In Belgium, there are no national criteria for ICU admission or discharge, and no policies regarding IMC care or for differentiating ICU intensity levels.

Aim/s: The aim of our study was to analyse the profile of ICU patients in Belgium on the basis of registered nursing activity in order to quantify the number of ICU days potentially transferable to an IMC.

Study design: The study was conducted on 310 ICU beds. Patients admitted to the study were recruited during two different one-month periods in 2018 and were included into a prospective database that evaluated nursing workload carried out in 15 hospitals in the French-speaking part of Belgium. The number of ICU days that could be supported on an IMC was defined according to the Nursing Activities Score (NAS) items.

Results: A total of 3279 ICU patients for a total of 13 942 ICU days were included. 4987 days (35.8%) were considered as "transferable" to an IMC. The proportion of ICU days transferable to an IMC was highly variable among hospitals, ranging from 20.4% to 59.5% of all ICU days. On the day of ICU admission, 665/2142 (31.0%) of the patients were already identified as transferable to an IMC; this percentage significantly increased on day 2 (972/2066, 47.1%) and day 3 (650/1390, 46.7%).

Conclusions: In Belgian ICUs, 35.8% of ICU hospital days, as per recorded NAS, do not necessitate intensive monitoring. These 35.8% of days of ICU hospitalization could be supported on an IMC.

Relevance for clinical practice: In this study, a significant number of days spent in the ICU could be supported on an IMC, this could alleviate the workload of nurses and reduce the occupancy rate of intensive care units.

Keywords: intermediate care unit; nursing activities score.