One year's experience with a noninvasively monitored intermediate care unit for pulmonary patients

Article Abstract:

The cost of health care in hospital intensive care units (ICUs) is high and the number of beds is limited, a situation that can force physicians to ration the use of these services according to criteria that are not always strictly 'medical'. Intermediate care units for cardiac patients who require intensive monitoring, but not intensive nursing, have been proposed. Patients with pulmonary disease may also be treated effectively in intermediate care units, but little data regarding the outcome of this approach have been presented. To address this issue, a follow-up study of all Medicare patients admitted to the noninvasive monitoring unit (NIMU) at one medical institution was performed. In the NIMU, patients' respiratory functions were continuously monitored using recently developed devices for recording breathing patterns. Patients were transferred or admitted to the NIMU according to their diagnosis and potential for deterioration; depending on their status, the unit functioned as a step-down unit (less intensive care than the patient had been receiving), step-up unit (more intensive care), or a longer-term facility for those who were giving up ventilatory support (breathing machine). Results for a one-year period showed that 94 patients were admitted to the NIMU a total of 104 times. Thirty-three of these admissions required ventilatory support, but all other patients could breathe independently. Approximately half the admissions followed respiratory failure on the regular medical wards. The bed costs saved by admitting patients to the NIMU instead of the ICU were $1,550 per admission, and more than $161,000 for the whole year. More than $4,200 was saved on each admission of a patient who required ventilatory support. Overall, the quality of care the patients received in the NIMU was high, although mortality in the ICU and NIMU were not compared. The results are important for developing alternative medical and economic solutions to the problem of overcrowded, expensive hospital ICUs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Innovations, Economic aspects, Patient monitoring, Physiologic monitoring, Respiratory disease nursing

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Intensive care of status asthmaticus: a 10-year experience

Article Abstract:

Because mortality from asthma has increased during the last decade, patients with life-threatening attacks have been increasingly admitted to intensive care units (ICUs). Hazards there, however, include the use of invasive instruments, intubation (insertion of a tube into the patient's airway), mechanical ventilation, and the possibility of contracting an infection in the hospital. To determine whether ICU treatment in fact reduces illness and death, investigators reviewed the records of 64 severely asthmatic adults who had a total of 80 episodes of status asthmaticus (a severe, intractable asthma attack) and were admitted to the ICU of one institution during a 10-year period. Fifty patients had been transferred to the ICU directly from the emergency department because they had suffered acute respiratory failure, the cessation of effective breathing. The patients were designated as members of Group 1 if they did not experience respiratory failure (30 episodes); Group 2, if they experienced respiratory failure but did not require mechanical ventilation (26 episodes); and Group 3, if they experienced respiratory failure and did need ventilation (24 episodes). Patients in Groups 2 and 3 (with one exception) had severe acidosis (bodily fluids had become too acidic), with those in Group 3 significantly more acidotic and hypercapnic (high levels of carbon dioxide in the blood). Complications (15) occurred primarily among Group 3 patients (13), and there were no deaths. Concerns about in-hospital deaths due to improper mechanical ventilation seem less warranted in light of the findings. Limiting the use of mechanical ventilation is desirable, and good medical management obviated its use in 26 cases in which patients were, in fact, severely acidotic. The ICU provides an ideal setting for asthmatics who develop respiratory failure or who are in continuous, intractable respiratory distress. (Consumer Summary produced by Reliance Medical Information, Inc.)

Asthma, Medical errors

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The necessary length of hospital stay for chronic pulmonary disease

Article Abstract:

Payments to hospitals have historically been based on norms derived from statistical analysis of prior hospital experience, not on a clinical evaluation of the expected course of the patients. Patients over 45 years of age who were diagnosed with chronic pulmonary disease (CPD, including chronic obstructive or restrictive pulmonary disease), asthma, and patients who had difficulty breathing or shortness of breath, were included in the study to determine the length of hospital stay they required. Eighty-three patients in two hospitals were observed for complications, critical events, and the need for monitoring. Ninety percent of the patients were free of complications and no longer needed monitoring after six days of hospitalization, but only after 16 days had 90 percent of patients been discharged. There was little correlation between a patient's ideal length of hospitalization and the time allotted for the diagnosis related group (DRG). At the time of admission, information is available to identify those who will need to stay longer, which would help physicians plan better, and communicate better with their patients. Better discharge planning can also reduce hospitalization times, as would alternatives to hospitalization during the time when full medical services are no longer needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Identification and classification, Hospital patients, Hospital utilization, Hospital stays, Diagnosis related groups

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