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Clinical Investigations in Critical Care; ArticlesThe Use of Risk Predictions to Identify Candidates for Intermediate Care Units: Implications for Intensive Care Utilization and Cost
Section snippets
Methods
This analysis is a part of the acute physiology and chronic health evaluation (APACHE) III study,21 an evaluation of severity and outcome in 42 ICUs at 40 hospitals. The entire data collection protocol was approved and the need for informed consent waived by the institutional review board at the George Washington University Medical Center, and also it was reviewed and approved at participating hospitals. The 40 participating hospitals included 26 nonfederal US hospitals with >200 beds selected
Characteristics of Hospitals, ICUs, and Patients
Among the 40 hospitals studied, 25 (63%) had residents or one or more accredited graduate medical training programs and 21 (53%) were affiliated with a medical school. Geographically, 17.5% were in the Northeast, 32.5% in the South, 30% in the Midwest, and 20% in the West. The mean number of hospital beds was 474 (range, 200 to 1,315 beds). The mean number of adult ICU beds at each hospital was 22 (range, 6 to 76 beds); and 25 hospitals (63%) had one or more intermediate care units. Among the
Discussion
Among 17,440 admissions to 42 ICUs at 40 US hospitals, we found that 8,040 patients (46%) received only technologic monitoring and concentrated nursing care during their first ICU day. Multivariate analysis indicated that risk for subsequent active life-supporting treatment among these monitoring admissions could be accurately predicted based on patient characteristics measured during the first ICU day. The predictors of risk for active treatment included diagnosis, the age and physiologic
ACKNOWLEDGMENTS
We acknowledge the data collection efforts and leadership of the hospitals involved in the APACHE III study.
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Supported by the Agency for Health Care Policy and Research (HSO 7137), the Department of Anesthesiology, George Washington University Medical Center, and APACHE Medical Systems, Inc.
APACHE and APACHE III are trademarks of APACHE Medical Systems (AMS), Inc. Drs. Knaus, Zimmerman, and Wagner are founders and shareholders of AMS, Inc, and are prohibited, by the University, from receiving any payment, royalties, or other fees from AMS. Elizabeth Draper, RN, MS, is an employee and shareholder of AMS. APACHE Medical Systems produces a management information system for critical care units, and holds the commercial copyright on the active treatment predictive equation and the APACHE III database. Although protected by commercial copyright, this equation is available to researchers for independent verification ana further analysis.