Epidemiology and prognoses in a medical intermediate care unit.

Abstract

The purpose of medical intermediate care units is the observation and treatment of patients with incipient or manifest organ failure. We wished to obtain data on which conditions result in admission to these units and the prognosis for these patients. All patients admitted to the medical intermediate care unit at Akershus University Hospital in 2014 were registered prospectively with reason for admission, period of hospitalisation, degree of severity, comorbidity, last place of hospitalisation prior to medical intermediate care and treatment limitations (do-not-resuscitate order and/or do-not-intubate order). Mortality in the hospital and one year after hospitalisation were registered retrospectively. Multiple regression analysis was performed with hospital mortality as the outcome variable. Altogether 1369patient hospitalisations for 1118 unique patients were included. The most frequent reasons for admission were pneumonia, chronic obstructive pulmonary disease, sepsis, poisonings and hyponatraemia. The degree of severity of the condition for which patients were admitted corresponded to that reported by intensive care departments in Norwegian local hospitals. A total of 13% died during their stay in hospital and a further 14% in the course of one year. The highest mortality was for patients with severe infection, cardiac failure and restrictive/neuromuscular respiratory disorder. The degree of severity, age, infection, comorbidity and ward as admitting unit were predictors of mortality during the hospitalisation period. Risk-adjusted mortality ratio of 0.64 satisfied the quality objective for intensive care departments (<0.7). A total of 5.6% of hospitalisations in the medical intermediate care unit entailed transfer to the intensive care ward. The degree of severity of the condition for which patients were admitted was high, and the treatment outcomes judged upon expected mortality were good. Medical intermediate care units can relieve pressure on wards with seriously ill patients without taking up intensive care beds.