Intermediate care units: an effective alternative to reduce intensive care unit admissions-a prospective cohort study

Background: Critically ill medical patients from the Emergency Department (ED) are admitted either to general wards or the Intensive Care Unit (ICU). This binary allocation may lead to suboptimal management of non-intensive critical patients, increasing ICU overcrowding. Intermediate Care Units (IMCUs) could be an effective alternative, but their ability to reduce avoidable ICU admissions remains unclear. Aim: To evaluate whether an IMCU could effectively manage acutely ill patients with potential ICU treatment needs and to assess its role in reducing avoidable ICU admissions while maintaining patient outcomes. Methods: This prospective observational study (January–December 2024) was conducted at the IMCU of Alto Vicentino Hospital, Santorso, Italy. All acute patients admitted to the IMCU were included, excluding step-down ICU transfers. Clinical characteristics, disease severity, and organ dysfunction were recorded. Patients were classified based on their potential ICU treatment need, and ICU exclusion criteria were documented. Primary outcomes were ICU transfer due to IMCU failure and 30-day mortality. Results: Among 678 patients, 40.4% (274/678) had potential ICU treatment needs. Overall, 92.6% had organ failure, and 41.3% had multiple organ dysfunctions. IMCU management avoided ICU admission in 203 of 274 patients (79.9%). ICU transfer rate was 6.9% (47/678), and 30-day mortality was 12.8% (87/678). Among ICU-potential patients, mortality was 16.4% (45/274), decreasing to 11.4% (27/236) in those without ICU exclusion criteria. Conclusions: These findings suggest that IMCUs may serve as an effective alternative for managing critically ill non-intensive care patients, reducing avoidable ICU admissions while maintaining clinical outcomes.