General intermediate care units: can they effectively support intensive care units and ensure patient safety? - Critical Care Science (CCS)

INTRODUCTION

Intermediate care units (IMCUs), also known as Step-Down Units (SDUs), were developed to bridge the care gap between a hospital’s general wards and the intensive care unit (ICU) by offering a level of care that is more intensive than that of general wards but less resource intensive than that of full ICUs.⁽⁾ Since their introduction in the early 1970s, IMCUs have evolved in terms of their physical structure and organizational aspects, such as staffing models, practices and types (general versus specialty-specific IMCUs), to meet the constantly changing demands of patients and health care systems.⁽⁾ Patients may be admitted to the IMCU either as a step-down from the ICU after a critical illness or as a step-up from the general wards when they are deteriorating or recovering after a low-risk surgical procedure.⁽⁾

Discharge from the ICU is a complex hospital process.⁽⁾ Approximately 1 in 10 ICU patients discharged to the wards will be readmitted to the ICU within 48 hours,⁽⁾ which is associated with increased length of hospital stay and higher hospital mortality and costs.⁽⁾ Intermediate care units may provide a safe environment for patients discharged from the ICU with a given risk of clinical deterioration because they are staffed with specialized interdisciplinary care teams and can provide close monitoring.⁽⁾ In the absence of an IMCU, such patients would either be transferred directly to regular wards, increasing their risk of ICU readmission and poor outcomes, or they would remain in the ICU, extending their length of stay and placing additional strain on ICU resources. This situation could preclude the ICU admission of critically ill patients with acute organ dysfunction or failure.⁽⁾

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