Heterogeneity of Intermediate Care Organization Within a Single Healthcare System
Intermediate care (IC) is prevalent nationwide, but little is known about how to best organize this level of care. Using a 99-item cross-sectional survey assessing four domains (hospital and physical IC features, provider and nurse staffing, monitoring, and interventions/services), we describe the o...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-01-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000001201 |
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| author | Aaron S. Case, MD, MHS Chad H. Hochberg, MD, MHS Binu Koirala, PhD, MGS, BSN, RN Eleni Flanagan, DNP, MBA Souvik Chatterjee, MD William N. Checkley, MD, PhD Ayse P. Gurses, PhD, MS, MPH David N. Hager, MD, PhD |
| author_facet | Aaron S. Case, MD, MHS Chad H. Hochberg, MD, MHS Binu Koirala, PhD, MGS, BSN, RN Eleni Flanagan, DNP, MBA Souvik Chatterjee, MD William N. Checkley, MD, PhD Ayse P. Gurses, PhD, MS, MPH David N. Hager, MD, PhD |
| author_sort | Aaron S. Case, MD, MHS |
| collection | DOAJ |
| description | Intermediate care (IC) is prevalent nationwide, but little is known about how to best organize this level of care. Using a 99-item cross-sectional survey assessing four domains (hospital and physical IC features, provider and nurse staffing, monitoring, and interventions/services), we describe the organizational heterogeneity of IC within a five-hospital healthcare system. Surveys were completed by nurse managers from 12 (86%) of 14 IC settings. Six IC settings (50%) were embedded within acute care wards, four (33%) were stand-alone units, and two (17%) were embedded within an ICU. All had a nurse-to-patient ratio of 1:3, provided continuous cardiac telemetry, continuous pulse oximetry, high-flow nasal oxygen, and bedside intermittent hemodialysis. Most (> 50%) permitted arterial lines, frequent nursing assessments (every 2 hr), and noninvasive ventilation or mechanical ventilation via a tracheostomy. Vasopressors were less often permitted (< 25% of settings). Models of IC vary greatly within a single healthcare system. |
| format | Article |
| id | doaj-art-5e83342859e5429ea7425f3c9342d0df |
| institution | Kabale University |
| issn | 2639-8028 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj-art-5e83342859e5429ea7425f3c9342d0df2025-01-24T09:19:28ZengWolters KluwerCritical Care Explorations2639-80282025-01-0171e120110.1097/CCE.0000000000001201202501000-00013Heterogeneity of Intermediate Care Organization Within a Single Healthcare SystemAaron S. Case, MD, MHS0Chad H. Hochberg, MD, MHS1Binu Koirala, PhD, MGS, BSN, RN2Eleni Flanagan, DNP, MBA3Souvik Chatterjee, MD4William N. Checkley, MD, PhD5Ayse P. Gurses, PhD, MS, MPH6David N. Hager, MD, PhD71 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD.1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD.2 School of Nursing, Johns Hopkins University, Baltimore, MD.3 Department of Medicine, Johns Hopkins Hospital, Baltimore, MD.1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD.1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD.4 Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University, Baltimore, MD.1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD.Intermediate care (IC) is prevalent nationwide, but little is known about how to best organize this level of care. Using a 99-item cross-sectional survey assessing four domains (hospital and physical IC features, provider and nurse staffing, monitoring, and interventions/services), we describe the organizational heterogeneity of IC within a five-hospital healthcare system. Surveys were completed by nurse managers from 12 (86%) of 14 IC settings. Six IC settings (50%) were embedded within acute care wards, four (33%) were stand-alone units, and two (17%) were embedded within an ICU. All had a nurse-to-patient ratio of 1:3, provided continuous cardiac telemetry, continuous pulse oximetry, high-flow nasal oxygen, and bedside intermittent hemodialysis. Most (> 50%) permitted arterial lines, frequent nursing assessments (every 2 hr), and noninvasive ventilation or mechanical ventilation via a tracheostomy. Vasopressors were less often permitted (< 25% of settings). Models of IC vary greatly within a single healthcare system.http://journals.lww.com/10.1097/CCE.0000000000001201 |
| spellingShingle | Aaron S. Case, MD, MHS Chad H. Hochberg, MD, MHS Binu Koirala, PhD, MGS, BSN, RN Eleni Flanagan, DNP, MBA Souvik Chatterjee, MD William N. Checkley, MD, PhD Ayse P. Gurses, PhD, MS, MPH David N. Hager, MD, PhD Heterogeneity of Intermediate Care Organization Within a Single Healthcare System Critical Care Explorations |
| title | Heterogeneity of Intermediate Care Organization Within a Single Healthcare System |
| title_full | Heterogeneity of Intermediate Care Organization Within a Single Healthcare System |
| title_fullStr | Heterogeneity of Intermediate Care Organization Within a Single Healthcare System |
| title_full_unstemmed | Heterogeneity of Intermediate Care Organization Within a Single Healthcare System |
| title_short | Heterogeneity of Intermediate Care Organization Within a Single Healthcare System |
| title_sort | heterogeneity of intermediate care organization within a single healthcare system |
| url | http://journals.lww.com/10.1097/CCE.0000000000001201 |
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