What is it about?
Scaling to an step-down rather than to the intensive care unit is an unproven practice that may be unsafe, and even dangerous, if the triage is incorrect.
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Why is it important?
The hospital mortality of undertriaged patients is significantly higher than for those patients correctly triaged (Chang LH et al. A mistaken step-up: rapid response calls triaged to intermediate care units [abstract]. Am J Respir Crit Care Med 2014;189:A3779) An step-down unit that operates independently and is not coordinated with the ICU may be a dangerous barrier to ICU admission, preventing adequate patient care, and may also increase costs (Solberg BC et al. Changes in hospital costs after introducing an intermediate care unit: a comparative observational study. Crit Care 2008;12:R68).
Perspectives
I hope that the reading of my letter facilitates the coordination of the clinical care of critical patients and impedes the independent performance of hospitalists or internal medicine doctors.
Dr. Pablo Monedero
Universidad de Navarra
Read the Original
This page is a summary of: Mistaken Step-Up Units, American Review of Respiratory Disease, May 2015, American Thoracic Society,
DOI: 10.1164/rccm.201502-0399le.
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