Otolaryngology care unit: a safe and cost-reducing way to deliver quality care.

Abstract

Patients undergoing treatment for head and neck cancer, obstructive sleep apnea, and potential airway obstruction are often unnecessarily admitted to an intensive care unit (ICU). This study determined the efficacy of an intermediate care unit (OtoCare Unit) for their management. A mail survey was conducted of 110 academic institutions' experience with intermediate care units; a retrospective study was performed of our ICU use with analysis of the use of invasive monitoring, length of stay, and cost; and a retrospective study of our first 168 OtoCare Unit patients and their outcomes, complications, and charges was performed. There were 56 responses to 110 survey inquiries. Thirty institutions used some form of intermediate care, while five had a separate otolaryngology unit. Analysis of our 1-year ICU experience showed that of 54 patients who underwent head and neck surgery, 36 patients were admitted to the ICU. Of these 36 admissions, only 9 patients required invasive monitoring and the majority had stable clinical courses. Guidelines were established for an OtoCare Unit: patients use non-ICU beds, mobile noninvasive monitoring units are provided, and a 1:4 nurse-to-patient ratio is used. Phase I included 35 patients who required a mandatory post-anesthesia care unit (PACU) stay of 4 hours. Three minor complications occurred in this group. Phase II included 133 patients who were permitted to enter the OtoCare Unit as soon as they recovered from anesthesia. There were nine minor complications and three major complications in this group. The charge savings compared with ICU usage for such patients was $35,762.00. An OtoCare Unit is a safe and cost-effective means of caring for this select group of patients.