How to maximize the benefits of the intermediate care unit in your hospital
Thursday, August 15, 2019
As a hospital manager, you know that an intermediate care unit (IMCU), also called a step-down unit, can be an efficient and safe asset when it comes to caring for patients who have left the ICU.
An IMCU allows for careful monitoring of patients who are showing progress in battling an acute illness; these units can also serve as a comfortable and safe place for patients in end-of-life care. Yet it can be difficult to determine ways that an IMCU can best function as a bridge from your ICU and how you can refocus its function to provide the optimal benefit to your patients.
The good news: research can help you make these determinations most easily. Follow these science-driven tips to make your IMCU as supportive as possible:
Identify which patients are most likely to experience surgical complications.
A two-part study by the University of Rochester found that 78% of patients who experience a post-op complication are readmitted to the hospital. To determine which patients in your care may fall into this category, the researchers recommend your doctors utilize the American College of Surgeons' Surgical Risk Calculator.
Then, patients who meet the criteria of high risk can be automatically transferred from the ICU to the IMCU so their conditions can be closely followed before they head to a general ward or are discharged too early.
Staff with continuity of care in mind.
Limit the number of doctors rotating in and out of your IMCU so the doctors you have staffed there can be intensively involved with each patient's trajectory. Also, choose the most competent observational nurses on your staff to work in the unit.
A study by Penn State College of Medicine discovered that rounds including a mix of professionals and nurses are most effective in terms of care. Focused, eagle-eyed nurses are essential for catching changes in breathing function.
Nurses should be the presenting clinician each morning to make sure patient status is most accurately related to the covering hospitalist.
Keep ICU congestion in mind — but don't make that your key concern.
A study from NYU and Columbia University found that IMCUs act as efficient conduits to solve capacity issues in ICUs. Still, it's key not to move patients too quickly. Work with your ICU team to make sure there is always reserved space for the most critical patients in the ICU and that patients heading to the IMCU don't go there too soon.
Look at cost-efficiency.
When a patient can benefit most from IMCU monitoring, on the other hand, make sure there aren't scheduling lags in making the transfer. IMCU care can reduce costs significantly, so making sure the appropriate acutely ill patients can receive that benefit as soon as possible can be very helpful.
Explain the purpose of the IMCU clearly to patients and their families.
An IMCU acts as a safe and secure buffer between the ICU and further care on a floor, or in a rehab or skilled nursing facility. Prepare your patients and their loved ones for what will happen transitionally in terms of care — the more they know what to expect both in and after time in the IMCU, the better they will feel psychologically — and that can have a powerfully positive effect on overall recovery.
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