A Proposal for an Intermediate Care Unit-Quality Measurement Framework

Table 1

Identified reported quality indicators with their range of values and frequencies of peporting.

	Quality indicator	Range		Number of studies reporting (N)
Intermediate Care Unit level	Mortality (%)	1.2–19.0		16
	Discharge-to-ICU rate (%)	1.6–10.0		7
	Length of stay (days)	0.9–4.0		6
	Readmission rate (%)	3.8–6.3		3
	Discharge-to-ICU <24 hours rate (%)	6.1		1
		Without IMCU	With IMCU
Intensive Care Unit level (difference with and without IMCU)	Mortality (%)	1.1–40.1	7.3–35.5	7
	Length of stay (days)	1.1–7.5	1.4–8.5	4
	Readmission rate (%)	5.0–9.0	5.8–15.8	3
	Caseload severity (APACHE III) [32]	13.4–34.5	14.2–49.6	4
	Inappropriate use of ICU beds: no active treatment (% of admission days)	3.2	0.01	1
	Inappropriate use of ICU beds: TISS-28 < 20 (% of admission days) [11]	18.7	9.7	1
	Low-risk monitor ICU admissions (%)	65.3	27.6	1
	Accessibility: refusal patients with ICU indication (%)	10.6	7.7	1
		Range
Hospital level	In-hospital mortality IMCU patients (%)	8.1–19.7		7
	In-hospital length of stay IMCU patients (days)	16.3–38.0		3
		Without IMCU	With IMCU
	In-hospital mortality ICU patients (%)	2.9–58.0	11.9–31.4	4
	In-hospital length of stay ICU patients (days)	11.0–26.5	13.9–37.3	2
	Overall in-hospital mortality (%)	2.2–4.5	3.2–3.9	2

This table shows the identified quality indicators at Intermediate Care level, Intensive Care level, and Hospital level. It also shows the range of values with the frequency of which each quality indicator was reported. The identified indicators frequently present are the IMCU (in-hospital) mortality, discharge-to-ICU rate, and the IMCU length of stay. The reported ranges are broad, indicating a large heterogeneity in IMCUs. Care should be taken not to ascribe a causal effect between the columns without the IMCU and with the IMCU, since no information regarding the difference per study can be extracted from this table. For more detailed information per included study, see Supplementary file 3. The only study at measuring IMCU quality at ICU level did so comparing the situation before the implementation with after the implementation of the ICU. No different designs or formats of IMCUs were compared. IMCU =Intermediate Care Unit; ICU = Intensive Care Unit; APACHE III = Acute Physiology and Chronic Health Evaluation III; TISS-28 = Therapeutic Intervention Scoring System-28.