0
September 5, 1990, Vol 264, No. 9 >
ARTICLE | September 5, 1990

One Year's Experience With a Noninvasively Monitored Intermediate Care Unit for Pulmonary Patients FREE

Bruce P. Krieger, MD; Patti Ershowsky, RRT; David Spivack, MRP
[+] Author Affiliations

Reprint requests to Division of Pulmonary Disease, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140 (Dr Krieger).


JAMA. 1990;264(9):1143-1146. doi:10.1001/jama.1990.03450090079031
Text Size: A A A
Published online
Article
References

Many studies have shown that selected cardiac patients can be safely and economically cared for in intermediate care units rather than intensive care units. However, there are only limited data concerning intermediate care units for pulmonary patients. We prospectively followed up all Medicare patients from May 5, 1987, through May 4, 1988, who were admitted to a pulmonary noninvasive monitoring unit. Ninety-four patients were admitted 104 times; 33 required mechanical ventilatory support for an average of 26 days. The overall cost savings were greater than $173 000, while high-quality medical care was maintained. We conclude that a noninvasive monitoring unit can be effectively used as an alternative to the intensive care unit for selected pulmonary patients.

(JAMA. 1990;264:1143-1146)

REFERENCES

1 +
Butler PW. Bone RC, Field T.  Technology under Medicare diagnosis-related groups prospective payment: implications for medical intensive care . Chest. 1985;;87:229-234.
2 +
Strauss MJ, LoGerfo JP, Yeltatzie JA, Temkin N, Hudson LD.  Rationing of intensive care unit services: an everyday occurrence . JAMA . 1986;; 255:1143-1146.
3 +
Kalb PE, Miller DH.  Utilization strategies for intensive care units . JAMA . 1989;;261:2389-2395.
4 +
Spivack D.  The high cost of acute health care: a review of escalating costs and limitations of such exposure in intensive care units . Am Rev Respir Dis. 1987;;136:1007-1011.
5 +
Wagner DP, Knaus WA, Draper EA, Zimmerman JE.  Identification of low-risk monitor patients within a medical-surgical intensive care unit . Med Care. 1983;;21:425-434.
6 +
Thibault GE, Mulley AG, Barnett GO, et al.  Medical intensive care: indications, interventions and outcomes . N Engl J Med. 1980;;302:938-942.
7 +
Fineberg HV, Scadden D, Goldman L.  Care of patients with a low probability of acute myocardial infarction: cost effectiveness of alternatives to coronary-care-unit admission . N Engl J Med. 1984;; 310:1301-1307.
8 +
Selker HP, Griffith JL, Dorey FJ, D'Agostino RB.  How do physicians adapt when the coronary care unit is full? a prospective multicenter study . JAMA . 1987;;257:1181-1185.
9 +
Sackner MA, Krieger BP.  Noninvasive respiratory monitoring . In: Scharf SM, Cassidy S, eds. Heart-Lung Interactions in Health and Disease . New York, NY: Marcel Dekker Inc; 1989;:663-805.
10 +
Rubins HB, Moskowitz MA.  Discharge decision making in a medical intensive care unit: identifying patients at high risk of unexpected death or unit readmission . Am J Med. 1988;;84:863-869.
11 +
Niehoff J, Del Guercio C, La Morte W, et al.  Efficacy of pulse oximetry and capnometry in post-operative ventilatory weaning . Crit Care Med. 1988;;16:701-705.
12 +
Krieger BP, Ershowsky P, Spivack D, Thorstenson J, Sackner MA.  Initial experience with a central respiratory monitoring unit as a cost-saving alternative to the intensive care unit for Medicare patients who require long-term ventilator support . Chest. 1988;;93:395-397.
13 +
Bone RC, Balk RA.  Noninvasive respiratory care unit: a cost effective solution for the future . Chest. 1988;;93:390-394.
14 +
Cullen DJ.  Results and costs of intensive care . Anesthesiology . 1977;;47:203-217.
15 +
Sackner MA, Watson H, Belsito AS, et al.  Calibration of respiratory inductive plethysmograph during natural breathing . J Appl Physiol. 1989;;66:410-420.
16 +
Krieger BP, Ershowsky P.  Noninvasive detection of respiratory failure in the intensive care unit . Chest. 1988;;94:254-261.
17 +
Hahn GJ, Shapiro SS. Statistics Model and Engineering . New York, NY: John Wiley & Sons Inc; 1967;.
18 +
Rosen RL, Bone RC.  Economics of mechanical ventilation . Clin Chest Med. 1988;;9:163-169.
19 +
Douglass PS, Rosen RL, Butler PW, Bone RC.  DRG payment for long-term ventilator patients: implications and recommendations . Chest. 1987;; 91:413-417.
20 +
Gracey DR, Gillespie D, Nobrega F, Naessens JM, Krishan I.  Financial implications of prolonged ventilator care of Medicare patients under the prospective payment system: a multicenter study . Chest. 1987;;91:424-427.
21 +
Wagner DP.  Economics of prolonged mechanical ventilation . Am Rev Respir Dis. 1989;;140: S14-S18.
22 +
Doubilet P, Weinstein MC, McNeil BJ.  Use and misuse of the term 'cost-effective' in medicine . N Engl J Med. 1986;;314:253-256.
23 +
Spicher JE, White DP.  Outcome and function following prolonged mechanical ventilation . Arch Intern Med. 1987;;147:421-425.
24 +
Morganroth ML, Morganroth JL, Nett LM, Petty TL.  Criteria for weaning from prolonged mechanical ventilation . Arch Intern Med. 1984;; 144:1012-1016.
25 +
Davis H, Lefrak SS, Miller D, Malt S.  Prolonged mechanical assisted ventilation: an analysis of outcome and charges . JAMA . 1980;;243:43-45.
26 +
Douglass PS, Bone RC, Rosen RL.  DRG payment for long-term ventilator patients: revisited . Chest. 1988;;93:629-631.
27 +
Bone RC.  Let's represent the interest of our patients . Chest. 1987;;91:317-318.
28 +
Gracey DR, Nobrega FT, Naessens JM, Krishan I.  Financial implications of prolonged ventilator care under DRGs 474 and 475 . Chest. 1989;;96:193-194.
29 +
Civetta JM, Hudson-Civetta JA.  Maintaining quality of care while reducing charges in the ICU: 10 ways . Ann Surg. 1985;;202:524-532.
30 +
Wagner DP, Knaus WA, Draper EA.  Identification of low-risk monitor admissions to medical-surgical ICUs . Chest. 1987;;92:423-428.
31 +
Wagner DP, Wineland TD, Knaus WA.  The hidden costs of treating severely ill patients: charges and resource consumption in the intensive care unit . Health Care Financ Rev. 1983;;5:81-86.
32 +
Krieger B, Feinerman D, Zaron A, Bizousky F.  Continuous noninvasive monitoring of respiratory rate in critically ill patients . Chest. 1986;; 90:632-634.
33 +
Drummond M, Stoddart G, Labelle R, Cushman R.  Health economics: an introduction for clinicians . Ann Intern Med. 1987;;107:88-92.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Butler PW. Bone RC, Field T.  Technology under Medicare diagnosis-related groups prospective payment: implications for medical intensive care . Chest. 1985;;87:229-234.
2 +
Strauss MJ, LoGerfo JP, Yeltatzie JA, Temkin N, Hudson LD.  Rationing of intensive care unit services: an everyday occurrence . JAMA . 1986;; 255:1143-1146.
3 +
Kalb PE, Miller DH.  Utilization strategies for intensive care units . JAMA . 1989;;261:2389-2395.
4 +
Spivack D.  The high cost of acute health care: a review of escalating costs and limitations of such exposure in intensive care units . Am Rev Respir Dis. 1987;;136:1007-1011.
5 +
Wagner DP, Knaus WA, Draper EA, Zimmerman JE.  Identification of low-risk monitor patients within a medical-surgical intensive care unit . Med Care. 1983;;21:425-434.
6 +
Thibault GE, Mulley AG, Barnett GO, et al.  Medical intensive care: indications, interventions and outcomes . N Engl J Med. 1980;;302:938-942.
7 +
Fineberg HV, Scadden D, Goldman L.  Care of patients with a low probability of acute myocardial infarction: cost effectiveness of alternatives to coronary-care-unit admission . N Engl J Med. 1984;; 310:1301-1307.
8 +
Selker HP, Griffith JL, Dorey FJ, D'Agostino RB.  How do physicians adapt when the coronary care unit is full? a prospective multicenter study . JAMA . 1987;;257:1181-1185.
9 +
Sackner MA, Krieger BP.  Noninvasive respiratory monitoring . In: Scharf SM, Cassidy S, eds. Heart-Lung Interactions in Health and Disease . New York, NY: Marcel Dekker Inc; 1989;:663-805.
10 +
Rubins HB, Moskowitz MA.  Discharge decision making in a medical intensive care unit: identifying patients at high risk of unexpected death or unit readmission . Am J Med. 1988;;84:863-869.
11 +
Niehoff J, Del Guercio C, La Morte W, et al.  Efficacy of pulse oximetry and capnometry in post-operative ventilatory weaning . Crit Care Med. 1988;;16:701-705.
12 +
Krieger BP, Ershowsky P, Spivack D, Thorstenson J, Sackner MA.  Initial experience with a central respiratory monitoring unit as a cost-saving alternative to the intensive care unit for Medicare patients who require long-term ventilator support . Chest. 1988;;93:395-397.
13 +
Bone RC, Balk RA.  Noninvasive respiratory care unit: a cost effective solution for the future . Chest. 1988;;93:390-394.
14 +
Cullen DJ.  Results and costs of intensive care . Anesthesiology . 1977;;47:203-217.
15 +
Sackner MA, Watson H, Belsito AS, et al.  Calibration of respiratory inductive plethysmograph during natural breathing . J Appl Physiol. 1989;;66:410-420.
16 +
Krieger BP, Ershowsky P.  Noninvasive detection of respiratory failure in the intensive care unit . Chest. 1988;;94:254-261.
17 +
Hahn GJ, Shapiro SS. Statistics Model and Engineering . New York, NY: John Wiley & Sons Inc; 1967;.
18 +
Rosen RL, Bone RC.  Economics of mechanical ventilation . Clin Chest Med. 1988;;9:163-169.
19 +
Douglass PS, Rosen RL, Butler PW, Bone RC.  DRG payment for long-term ventilator patients: implications and recommendations . Chest. 1987;; 91:413-417.
20 +
Gracey DR, Gillespie D, Nobrega F, Naessens JM, Krishan I.  Financial implications of prolonged ventilator care of Medicare patients under the prospective payment system: a multicenter study . Chest. 1987;;91:424-427.
21 +
Wagner DP.  Economics of prolonged mechanical ventilation . Am Rev Respir Dis. 1989;;140: S14-S18.
22 +
Doubilet P, Weinstein MC, McNeil BJ.  Use and misuse of the term 'cost-effective' in medicine . N Engl J Med. 1986;;314:253-256.
23 +
Spicher JE, White DP.  Outcome and function following prolonged mechanical ventilation . Arch Intern Med. 1987;;147:421-425.
24 +
Morganroth ML, Morganroth JL, Nett LM, Petty TL.  Criteria for weaning from prolonged mechanical ventilation . Arch Intern Med. 1984;; 144:1012-1016.
25 +
Davis H, Lefrak SS, Miller D, Malt S.  Prolonged mechanical assisted ventilation: an analysis of outcome and charges . JAMA . 1980;;243:43-45.
26 +
Douglass PS, Bone RC, Rosen RL.  DRG payment for long-term ventilator patients: revisited . Chest. 1988;;93:629-631.
27 +
Bone RC.  Let's represent the interest of our patients . Chest. 1987;;91:317-318.
28 +
Gracey DR, Nobrega FT, Naessens JM, Krishan I.  Financial implications of prolonged ventilator care under DRGs 474 and 475 . Chest. 1989;;96:193-194.
29 +
Civetta JM, Hudson-Civetta JA.  Maintaining quality of care while reducing charges in the ICU: 10 ways . Ann Surg. 1985;;202:524-532.
30 +
Wagner DP, Knaus WA, Draper EA.  Identification of low-risk monitor admissions to medical-surgical ICUs . Chest. 1987;;92:423-428.
31 +
Wagner DP, Wineland TD, Knaus WA.  The hidden costs of treating severely ill patients: charges and resource consumption in the intensive care unit . Health Care Financ Rev. 1983;;5:81-86.
32 +
Krieger B, Feinerman D, Zaron A, Bizousky F.  Continuous noninvasive monitoring of respiratory rate in critically ill patients . Chest. 1986;; 90:632-634.
33 +
Drummond M, Stoddart G, Labelle R, Cushman R.  Health economics: an introduction for clinicians . Ann Intern Med. 1987;;107:88-92.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems