(1481) Impact of the Elimination of Intermediate Care Units: Are Intermediate Care Units Necessary?

Introduction: Over the last several decades many hospitals created intermediate care units (IMCU) to provide care for patients who require an increase in care but do not require ICU level of care. Several IMCU models have been used, with the goals of improved ICU utilization and clinical outcomes as well as decreased costs. However, limited data are available as to the effectiveness of IMCU. We examined the impact of eliminating IMCU on ICU utilization and clinical outcomes.

Methods: The study was a retrospective before-after study. In April 2019, 34 IMCU beds in a 540-bed tertiary care hospital were eliminated. Data was collected in the 12-month periods before and after IMCU elimination. ICU utilization and clinical outcomes were evaluated.

Results: Total hospital admissions, demographics, and comorbidities were comparable pre and post IMCU elimination. ICU admissions post IMCU elimination increased 26% (13% hospital admissions pre versus 17% of hospital admissions post, p< 0.001). Post elimination the proportion of ED to ICU admissions increased (31% versus 24%, p< 0.01) as did inpatient to ICU admissions (41% versus 38%, p< 0.01). Post elimination ICU length of stay was shorter (median 70 (40,123) hours versus 82 (46,137) hours, p< 0.001) as was hospital length of stay (median 128 (72,223) hours versus 148 (86,251) hours, p< 0.001). Overall, ICU days were only 13% higher post elimination, while total hospital days were 10% lower. Post IMCU elimination ICU mortality was significantly lower (9.8% versus 8.2%, p=0.008), as was hospital mortality (14.2% versus 11.9%, p=0.001). There was an increase in in-hospital cardiac arrests and rapid response activations in the post elimination period. Adjusted odds ratio for ICU and hospital mortality were significantly lower post elimination, OR 0.83 (0.71, 0.96) and OR 0.81 (0.72, 0.92) respectively while the odds ratio for rapid response activation was significantly higher, OR 1.33 (1.07, 1.65). There was no increase in the odds of in-hospital cardiac arrest post elimination.

Conclusions: Elimination of IMCU increased ICU utilization. However, clinical outcomes in fact improved without IMCU. This raises questions as to the role of IMCU versus ICU in providing an increase in the level of care within a hospital structure.