Creation and Expansion of a Mixed Patient Intermediate Care Unit to Improve ICU Capacity

OBJECTIVES

ICU capacity strain is associated with worsened outcomes. Intermediate care units (IMCs) comprise one potential option to offload ICUs while providing appropriate care for intermediate acuity patients, but their impact on ICU capacity has not been thoroughly characterized. The aims of this study are to describe the creation of a medical-surgical IMC and assess how the IMC affected ICU capacity.

DESIGN

Descriptive report with retrospective cohort review.

SETTING

Six hundred seventy-three-bed tertiary care academic medical center with 77 ICU beds.

PATIENTS

Adult inpatients who were admitted to the IMC.

INTERVENTIONS

An interdisciplinary working group created an IMC which was located on a general ward. The IMC was staffed by hospitalists and surgeons and supported by critical care consultants. The initial maximum census was three, but this number increased to six in response to heightened critical care demand. IMC admission criteria also expanded to include advanced noninvasive respiratory support defined as patients requiring high-flow nasal cannula, noninvasive positive pressure ventilation, or mechanical ventilation in patients with tracheostomies.

MEASUREMENTS AND MAIN RESULTS

The primary outcome entailed the number of ICU bed-days saved. Adverse outcomes, including ICU transfer, intubation, and death, were also recorded. From August 2021 to July 2022, 230 patients were admitted to the IMC. The most frequent IMC indications were respiratory support for medical patients and post-operative care for surgical patients. A total of 1023 ICU bed-days were made available. Most patients were discharged from the IMC to a general ward, while 8% of all patients required transfer to an ICU within 48 hours of admission. Intubation (2%) and death (1%) occurred infrequently within 48 hours of admission. Respiratory support was the indication associated with the most ICU transfers.

CONCLUSIONS

Despite a modest daily census, an IMC generated substantial ICU bed capacity during a time of peak critical care demand.

E-mail, the Internet, and information access technology in pathology

In the Age of Information, the Internet has become a fast, powerful, international information resource that has forever transformed the way we view and use information. The need to quickly access, search, and manage information has grown into a challenging task as the amount of information that is available has grown exponentially over the past few years. As people venture onto this growing information superhighway, traveling may be fast and easy for the expert user, but for most, the trip can be intimidating. For the pathologist who faces overwhelming amounts of printed information today, there is an increasing need for tools to manage medical informatics. The Internet has become the toolbox for many to efficiently search, find and manage information. However, just as the information itself steadily becomes more and more abundant and complex, the Internet continues to grow more and more sophisticated. This sophistication oftentimes leads to more confusion and may actually limit its potential to users. In an attempt to demystify the Internet, this article will discuss its basic features and functions with a focus on information resources available to the pathologist such as E-mail, Gopher, and the World Wide Web. Knowledgeable use of the Internet and its vast resources will greatly increase the quality of patient care.

[Serological diagnostic studies of the occurrence of coronavirus infections in cattle with respiratory diseases]

Of paired serum samples of 196 cattle with respiratory disease from 37 herds which were tested for hemagglutination inhibiting antibodies against coronavirus (BCV) 185 of the first specimens and 190 of the second ones gave positive results. This difference was due to five animals of five different farms showing seroconversions between the time of the blood collections. A significant rise in antibody titer (no less than 4-fold) was evident in 28 cattle from 3 of the above mentioned and 12 other farms. Altogether serological indication of acute coronavirus infections were gained in 33 (16.8%) of animals with respiratory diseases which derived from 17 of 37 herds. Most of these infections (about 35%) occurred in animals older than 6 months while calves up to 3 or 6 months were only affected in a ratio of ca. 10%, respectively.

The potency-sparing radical cystectomy: does it compromise the completeness of the cancer resection?

Anatomical radical cystectomies with en bloc pelvic lymph node dissections were performed post mortem on 10 male cadavers. The traditional technique of radical cystectomy was used on 1 side and the potency-sparing technique was used on the opposite side. The tissue responsible for the differences in the surgical margins with the 2 procedures was examined by routine surgical pathological techniques to determine if it contained lymph nodes. Lymph nodes were identified in the bundle of tissue left in the pelvis with the nerve-sparing radical cystectomy in 6 of the 10 dissections (60 per cent). Because these lymph nodes may represent the potential first site of metastatic disease leaving the bladder, the reader is cautioned about adopting the nerve-sparing radical cystectomy as part of the management of invasive bladder cancer until the long-term sequelae of the procedure are known.