Where internal medical patients receive intensive interventions: results from a tertiary-care hospital in Israel

Author:

Leibner Gideon,Brammli-Greenberg Shuli,Katz David,Esayag Yaakov,Kaufman Nechama,Rose Adam J.

Abstract

Abstract Background Patients admitted to internal medicine may be moved to more advanced-care settings when their condition deteriorates. In these advanced care settings, there may be higher levels of monitoring and greater ability to deliver Intensive Medical Treatments (IMTs). To the best of our knowledge, no previous study has examined the proportion of patients at different levels of care who receive different types of IMTs. Methods In this retrospective observational cohort study, we examined data from 56,002 internal medicine hospitalizations at Shaare Zedek Medical Center, between 01.01.2016 and 31.12.2019. Patients were divided according to where they received care: general-ward, Intermediate-Care Unit, Intensive Care Unit (ICU), or both (Intermediate-Care and ICU). We examined the rates at which these different groups of patients received one or more of the following IMTs: mechanical ventilation, daytime bi-level positive airway pressure (BiPAP), or vasopressor therapy. Results Most IMTs were delivered in a general-ward setting – ranging from 45.9% of IMT-treated hospitalizations involving combined mechanical ventilation and vasopressor therapy to as high as 87.4% of IMT-treated hospitalizations involving daytime BiPAP. Compared to ICU patients, Intermediate-Care Unit patients were older (mean age 75.1 vs 69.1, p < 0.001 for this and all other comparisons presented here), had longer hospitalizations (21.3 vs 14.5 days), and were more likely to die in-hospital (22% vs 12%). They were also more likely to receive most of the IMTs compared to ICU patients. For example, 9.7% of Intermediate-Care Unit patients received vasopressors, compared to 5.5% of ICU patients. Conclusion In this study, most of the patients who received IMTs actually received them in a general-bed and not in a dedicated unit. These results imply that IMTs are predominantly delivered in unmonitored settings, and suggest an opportunity to re-examine where and how IMTs are given. In terms of health policy, these findings suggest a need to further examine the setting and patterns of intensive interventions, as well as a need to increase the number of beds dedicated to delivering intensive interventions.

Funder

the Institute for Health Policy Research

Israel Institute for Health Policy Research

Publisher

Springer Science and Business Media LLC

Subject

Public Health, Environmental and Occupational Health,Health Policy

Reference28 articles.

1. Egol A. Guidelines for intensive care unit admission, discharge, and triage. Task force of the American college of critical care medicine, society of critical care medicine. Crit Care Med. 1999;27(3):545–51.

2. Defining minimum standards for adult intensive care units, position paper of the Israeli association for intensive medical care [Internet]. 2014 [cited 2022 Nov 18]. Available from: https://www.ima.org.il/MainSiteNew/EditClinicalInstruction.aspx?ClinicalInstructionId=227.

3. Hospital beds and licensed positionse [Internet]. Jerusalem, Israel; 2021. Available from: https://www.health.gov.il/PublicationsFiles/beds2021.pdf.

4. Health care resources [Internet]. [Cited 2022 Nov 18]. Available from: https://stats.oecd.org/index.aspx?DataSetCode=HEALTH_REAC.

5. Boots R, Lipman J. High dependency units: issues to consider in their planning. Anaesth Intensive Care. 2002;30(3):348–54.

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3