Intensive care patients eligible for intermediate care unit-level care: a single-centre prospective cohort study in Belgium

TL;DR

This study finds that a significant portion of ICU days could be managed at a lower care level, potentially improving hospital efficiency and patient care.

Contribution

The study introduces a method to identify ICU patients suitable for intermediate care, linking this to improved ICU bed availability and nursing workload.

Findings

16.7% of ICU hospitalization days were eligible for intermediate care unit-level management.

Intermediate care unit-eligible days correlated with fewer ICU and hospital-free days.

Nursing workload was significantly lower for intermediate care unit-eligible patients.

Abstract

To estimate the number of intensive care unit hospitalization days that could have been managed at an intermediate care unit level and to assess the impact of intermediate care unit-eligible patients on intensive care unit-free days, hospital-free days, and nursing workload.

This single-center, prospective cohort study included all patients admitted to the intensive care unit of an academic hospital between June 1, 2021, and May 31, 2022. All adult (> 18 years of age) patients with an intensive care unit stay exceeding 24 hours were eligible for inclusion. Data from a total of 1,547 patients were analysed. Daily, intensive care unit head nurses identified patients eligible for intermediate care unit management based on predefined criteria. Nursing workload was quantified using the Nursing Activities Score, and 16,478 Nursing Activities Score assessments, recorded at the end of each nursing shift, were collected.

A total of 1,457 intensive care unit hospitalization days (16.7% of the total) were classified as eligible for intermediate care unit-level management. An increase in cumulative intermediate care unit days was significantly associated with fewer intensive care unit - and hospital-free days (adjusted incidence rate ratio = 0.98 [95%CI 0.97 - 0.99] for both). A strong negative correlation was observed between the monthly proportion of intermediate care unit-eligible intensive care unit days and the intensive care unit occupancy rate (R = −0.703, p = 0.011). By shift, the median Nursing Activities Score for intensive care unit patients was 72.4 [59.6 - 87.5] compared to 63.5 [52.6 - 72.8] for intermediate care unit-eligible patients in the morning, 71.5 [58.1 - 86.6] versus 56 [47.8 - 66.1] in the afternoon and 66.1 [53.5 - 81.1] versus 53.9 [45 - 64.7] during night shifts (p < 0.001 for all).

This study highlights the potential impact of early identification of intermediate care unit-eligible patients on optimizing the use of intensive care unit beds and improving the organization of patient care. A lower Nursing Activities Score might help select patients for intermediate care unit care, supporting the clinical relevance of such a score in the daily assessment of intensive care unit patients.

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