Construction of reference criteria to admit patients to intermediate care units in France: a Delphi survey of intensivists, anaesthesiologists and emergency medicine practitioners (first part of the UNISURC project)

Benoît Misset; Philippe Aegerter; Rym Boulkedid; Corinne Alberti; Christophe Baillard; Bertrand Guidet; Marc Beaussier

doi:10.1136/bmjopen-2023-072836

Construction of reference criteria to admit patients to intermediate care units in France: a Delphi survey of intensivists, anaesthesiologists and emergency medicine practitioners (first part of the UNISURC project)

BMJ Open. 2023 Jul 24;13(7):e072836. doi: 10.1136/bmjopen-2023-072836.

Authors

Benoît Misset^{1

2

3

4

5}, Philippe Aegerter^{6

7

8}, Rym Boulkedid⁹, Corinne Alberti¹⁰, Christophe Baillard^{3

11}, Bertrand Guidet¹², Marc Beaussier¹³

Affiliations

¹ Department of Intensive Care, Groupe hospitalier Paris Saint-Joseph, Paris, France benoit.misset@chuliege.be.
² Department of Intensive Care, CHU de Liege - Hopital du Sart Tilman, Liege, Belgium.
³ Paris University, Paris, France.
⁴ University of Rouen Normandie, Rouen, France.
⁵ University of Liège, Liège, Belgium.
⁶ Epidemiology and Public Health Service, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicetre, France.
⁷ University of Versailles Saint-Quentin, Versailles, France.
⁸ INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
⁹ Unité d'Epidémiologie Clinique, INSERM CIC 1426, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France.
¹⁰ Unité d'Epidémiologie Clinique, AP-HP, Paris, France.
¹¹ Department of Anesthesia and Intensive Care, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France.
¹² Department of Intensive Care, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France.
¹³ Anesthesiology, Institut Mutualiste Montsouris, Paris, France.

Abstract

Objectives: No consensus criteria describe the medical eligibility of the patients to intermediate care units (IMCUs). In this first part of the UNISURC project, we aimed to develop criteria based on a consensus of physicians from the main specialties involved in IMCU admission decisions.

Design: We selected criteria from IMCU literature, scoring systems and intensive care unit nursing workload. We submitted these criteria to a panel of experts in a Delphi survey. We used a two-round Delphi survey procedure to assess the validity and feasibility of each criterion.

Setting: Medical practitioners in either public or private French institutions and proposed by the national scientific societies of anaesthesiology, emergency medicine and intensive care. The Delphi rounds took place in 2015-2016.

Outcome measures: Validity and feasibility of the proposed criteria; uniformity of the judgement across the primary specialty and the hospital category of the responders.

Results: The criteria submitted to vote were classified as one of: chronic factor (CF); acute factor (AF); specific pathway (SP); nursing activity (NA) and hospital environment (HE). Of 189 experts invited, 81 (41%) responded to the first round and 62 of them (76%) responded to the second round. A definite selection of 63 items was made, distributed across 6 CF, 18 AF, 31 SP, 3 NA and 5 HE. Validity and feasibility were influenced by the specialty or the public/private status of the institution of the responders for a few items.

Conclusion: We created a set of 63 consensus criteria with acceptable validity and feasibility to assess the medical eligibility of the patients to IMCUs. The second part of the UNISURC project will assess the distribution of each criterion in a prospective multicentre national cohort.

Trial registration number: NCT02590172.

Keywords: Adult intensive & critical care; Hospitalization; PUBLIC HEALTH.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Delphi Technique
Emergency Medicine*
Hospitalization*
Humans
Intensive Care Units
Prospective Studies
Surveys and Questionnaires

Associated data

ClinicalTrials.gov/NCT02590172