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Structural models for intermediate care areas.

D C Cheng·R J Byrick·E Knobel
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Abstract

OBJECTIVE: To describe structural models of intermediate care units used for critically ill patients. DATA SOURCES: Three multidisciplinary units with varying structures and functions of intermediate care areas (ICAs) are described. DATA SYNTHESIS: Advantages and limitations for each of the three models are outlined. The structural models described are the conventional isolated ICA model, the parallel model, and the integrated model of ICA. CONCLUSION: Each structural model has advantages and limitations. Selection of the appropriate ICA model for an institution depends on the specific circumstances and needs of the institution. Each of the three models can facilitate improved utilization of critical care resources.

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Critical IllnessHealth Care CostsHumansIntensive Care UnitsIntermediate Care FacilitiesMedical Staff, HospitalModels, StructuralWorkloadJournal ArticleReview

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BibTeXRIS

D C Cheng, R J Byrick, E Knobel. 1999. Structural models for intermediate care areas.. https://doi.org/10.1097/00003246-199910000-00034

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OBJECTIVES: The study compared a hand-carried echocardiography (HC) device with standard echocardiography (SE) in critically ill patients. BACKGROUND: Recently, small HC devices have been introduced, and early reports showed a good correlation with SE. METHODS: We used HC (SonoSite, Bothell, Washington) echocardiography to evaluate critically ill patients, and we compared the results with SE obtained with state-of-the-art equipment (Sonos 5500, Hewlett-Packard, Andover, Massachusetts). Each of 80 critically ill patients was studied twice (HC and SE). The studies were done and interpreted separately in blinded fashion. RESULTS: The HC device missed a clinical finding related to the reason for referral in 31% of patients. In 19% of patients a clinically important finding separate from the indication for echocardiography was also missed. The total number of patients with one or more missed findings was 36 (45%). Findings were missed by HC for several reasons. First, HC does not contain spectral Doppler, electrocardiographic, or M-mode capabilities. Two-dimensional imaging is superior on SE, with improved image processing. In addition, although HC does contain color power Doppler, it does not have true color flow Doppler imaging. Therefore, HC often failed to detect or accurately quantify valvular regurgitation. CONCLUSIONS: Although the HC device was able to provide important anatomic information, the device falls far short of SE in the evaluation of critically ill patients.

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