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Results of a retrospective observational study of intermediate care staffed by hospitalists: Impact on mortality, co‐management, and teaching
Author(s) -
Lucena Juan Felipe,
Alegre Félix,
Rodil Raquel,
Landecho Manuel Fortún,
GarcíaMouriz Alberto,
Marqués Margarita,
Aquerreta Irene,
García Nicolás,
Quiroga Jorge
Publication year - 2012
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.1905
Subject(s) - medicine , observational study , hospital medicine , retrospective cohort study , perioperative , demographics , mortality rate , emergency medicine , intensive care medicine , surgery , demography , sociology
BACKGROUND: Hospitalized patients are complex and institutions have to face the high cost of critical care and the limited resources of the ward. Intermediate care appears as an attractive strategy to provide rational care according to patient needs. It is an interesting scenario to expand co‐management and teaching. STUDY DESIGN: Retrospective observational study. SETTING: Intermediate care unit (ImCU) of a single academic hospital. PATIENTS AND METHODS: 456 patients admitted from April 2006 to April 2010 were included in the study. Demographics, admission physiologic parameters and in‐hospital mortality were recorded. We used the Simplified Acute Physiology Score II (SAPS II) as prognostic score system. Co‐management with medical and surgical teams, and the number of training residents were evaluated. RESULTS: In‐hospital mortality was 20.6%, whereas the expected mortality was 23.2% based on SAPS II score. The correlation between SAPS II predicted and observed death rates was accurate and statistically significant (Rho = 1.0, p < 0.001). Co‐management was performed with several medical and surgical teams, with an increase in perioperative comanagement of 22.7% (p = 0.014). The number of training residents in ImCU increased from 4.3% to 30.4% (p = 0.002) CONCLUSIONS: An ImCU led by hospitalists showed encouraging results regarding patient survival and SAPS II is an useful tool for prognostic evaluation in this population. Intermediate care serves as an expansion of role for hospitalists; and clinicians, trainees and patients may benefit from co‐management and teaching opportunities at this unique level of care. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine