The intermediate care unit as a cost-reducing critical care facility in tertiary referral hospitals: a single-centre observational study

Abstract

Objectives To determine whether and to what extent the surgical intermediate care unit (IMCU) reduces healthcare costs. Design Retrospective cohort study. Setting The mixed-surgical IMCU of a tertiary academic referral hospital. Participants All admissions (n=2577) from 2012 to 2015. Primary and secondary outcome measures The outcome measure was the hypothetical cost savings due to the presence of the IMCU. For this, each admission day was classified as either low-acuity or high-acuity, based on the Therapeutic Intervention Scoring System-28, the required specific nursing interventions and the indication for admission at the IMCU. Costs (2018) used were €463 per hospital ward, €1307 per IMCU and €2224 per intensive care unit (ICU) admission day. Savings were calculated by subtracting the actual IMCU costs from the hypothetical costs in the absence of the IMCU. Results There were 9037 admission days (n=2577\u2009admissions) at the IMCU. The proportion of high-acuity admissions was 87.6%. Total costs at the IMCU were €11.808 888. Total hypothetical costs in absence of the IMCU were €18.115 284. Total cost savings were thus €6.306 395, or €1.576 599, per year. Conclusions The surgical IMCU may substantially reduce societal healthcare costs, making it a cost saving alternative to ICU care. Constant adequate triage is essential to optimise its potential.