Experience in the Cohort Intermediate Care Unit Arrangement and Nursing management of patients with COVID-19 at Bangkok Hospital Headquarters

Main Article Content

Chutikan Suwalapha, RN, MBA
Thitaree Yongprawat
Wirongrong Charoengid, RN, MNS
Pornpimol Laongam, RN, MBA


OBJECTIVES: To share experiences for the Cohort Intermediate Care Unit (IMCU) setup description. It also involves the focusing on integrated nursing care in collaboration with Multi-professional team to improve patient outcomes.

MATERIALS AND METHODS: We collected and searched many articles from the published medical literature that reported standard protocols for the IMCU and nursing management of SARS-CoV-2 (COVID-19). This study was a collection of data from COVID-19 patients who were confirmed cases with positive real time-PCR test results. They were receiving treatment and admitted at Bangkok Hospital Headquarters (BHQ) from May 1st- June 30th, 2021. Descriptive statistics were used to describe the results in frequency, percentage and mean. We compared the average number of days for COVID-19 patients stay between two groups. A confidence interval (CI) was used to explain a different sample proportion and a different interval of hospital mortality rate.

RESULT: Among 122 COVID-19 patients, 41 (33.6%) patients were admitted to the Cohort IMCU. The average length of stay (LoS) was 5.1 days, with minimum 1 day and maximum 15 days. Three quarter of them (31/41, 75.6%) had clinical improvement and were transferred to Cohort ward, while a quarter (10/41, 24.4%) had experienced clinical deterioration and were transferred to intensive care unit (ICU). Mortality rate of this group was 4.9% (95%CI -1.7, 11.5). During the same time period, 81 COVID-19 patients were directly transferred to ICU. The average LoS in ICU of 6.2 days. Among them, 8 of 81 patients did not survive. As a result, mortality rate among this group was 9.9% (95%CI 3.4, 16.4).

CONCLUSION: In our experience, the Cohort IMCU can reduce mortality rate of the COVID-19 patients and proper management also decrease crowding of ICU.


Download data is not yet available.

Article Details

How to Cite
Suwalapha, RN, MBA C, Yongprawat T, Charoengid, RN, MNS W, Laongam, RN, MBA P. Experience in the Cohort Intermediate Care Unit Arrangement and Nursing management of patients with COVID-19 at Bangkok Hospital Headquarters. BKK Med J [Internet]. 2021 Sep. 29 [cited 2023 Dec. 2];17(2):161. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/252297
Speacial Feature


Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92(4):401-2.

Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020;579(7798):270-3.

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA Netw Open 2020;323(13):1239-42.

Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Bio Med 2020;91(1):157-60.

International cooperation office, Department of Disease Control. Assessing the risk of spread of COVID-19 (2019- nCoV) to the Asia Pacific region [Internet]. Bangkok: 2020. (Accessed January 24, 2021, at https://www.ddcmoph.com/file/RiskAssessment/ThaiVers_240163.pdf ).

Department of disease control, Ministry of Public Health. COVID-19 situation report [Internet]. Bangkok: 2021. (Accessed June 3, 2021, at https://www.covid19.ddc.moph.go.th ).

Chua GT, Wong JSC, Lam I, et al. Clinical characteristics and transmission of COVID-19 in children and youths during 3 waves of outbreaks in Hong Kong. JAMA Netw Open 2021;4(5):e218824-e.

Ferrando C, Sipmann FS, Artigas RM, et al. Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive Care Med 2020;46(12):2200-11.

Zhuang Z, Cao P, Zhao S, et al. The shortage of hospital beds for COVID-19 and non-COVID-19 patients during the lockdown of Wuhan, China. Ann Transl Med 2021;9(3):200.

World Health Organization. Naming SARS-CoV-2 variants [Internet]. Geneva: WHO; 2021 (Accessed June 5, 2021, at https://www.who.int/en/activities/tracking-SARS-CoV-2-variants ).

Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-62.

Kuppuswamy R, Sharma SK. Efficient utilization of nursing manpower during the COVID-19 pandemic. Pondicherry J Nurs 2020;13(2):39-42.

Infection control department: Bangkok Hospital Headquarters. Isolation Precautions (Prevention of infection and Control of the spread of infection). Bangkok Hospital Headquarters. Patient Safety Goal 5 (Prevention and control the risk of healthcare associated infections). Policy Document. Bangkok: Bangkok Hospital Headquarters; 2019 Aug 29. Document No.: S/P-02.1-BHQ-050.

Department of Medical Services. Ministry of Public Health and University Hospital Network (UHosNet). Guidelines for the establishment of Cohort Ward, Isolation room and Field Hospital [Internet]. Bangkok: 2021 (Accessed May 14, 2021, at https://www.covid19.dms.go.th/backend/Content/Content_File/Covid_Health/Attach/25640129093347AM ).

Department of Medical Services. Ministry of Public Health. Guidelines for care of critically ill patients in the COVID-19 pandemic situation [Internet]. Bangkok: 2021. (Accessed May 13, 2021, at

https://www.covid19.dms.go.th/Content/Select_Landding_page?contentId=73 ).

Department of Medical Services. Ministry of Public Health. Guidelines on clinical practice, diagnosis, treatment, and prevention of healthcare-associated infection for COVID-19 for medical professionals and public health personnel [Internet]. Bangkok: 2021. (Accessed April 19, 2021, at

https://www.ddc.moph.go.th/viralpneumonia/eng/file/guidelines/g_CPG_06may21.pdf ).

Centers for Disease Control and Prevention. Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19) [Internet]. Bangkok: 2021. (Accessed April 19, 2021, at

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-riskassesment-hcp.html ).

Bangkok Hospital Headquarters. Guidelines for care and prevention of Coronavirus Disease 2019 infection. Work Procedure Document. Bangkok: Bangkok Hospital Headquarters; 2020 Nov 16. Document No.: W/P-02.1-IC-041.

Waydhas C, Herting E, Kluge S, et al. Intermediate care units. Med Klin Intensivmed Notfallmed 2018;113(1):33-44.

Plate JDJ, Leenen LPH, Houwert M, et al. Utilisation of intermediate care units: a systematic review. Crit Care Res Pract 2017;2017:8038460. doi:10.1155/2017/8038460

Bhimraj A, Morgan RL, Shumaker AH, et al. Infectious diseases society of America guidelines on the treatment and management of patients with coronavirus disease 2019 (COVID-19) [Internet]. Virginia: 2021 (Accessed Mar 18, 2021, at https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management ).

Simpson CE, Sahetya SK, Bradsher RW, et al. Outcomes of emergency medical patients admitted to an intermediate care unit with detailed admission guidelines. Am J Crit Care 2017;26(1):e1-10.

Shenoy N, Luchtel R, Gulani P. Considerations for target oxygen saturation in COVID-19 patients: are we under-shooting? BMC Med 2020;18(1):260.

World Health Organization. Clinical management of COVID-19. an interim guidance [Internet]. Geneva: WHO; 2021. (Accessed June 1, 2021, at https://www.who.int/en/activities/tracking-SARS-CoV-2-variants ).

Department of Medical Sciences. Ministry of Public Health. Manual of Laboratory and Diagnostic Tests for Coronavirus Disease 2019 (COVID19). April 21, 2020: 6. [Internet]. 2021. (Accessed April 19, 2021, at

https://www.ddc.moph.go.th/viralpneumonia/eng/file/guidelines/G_en_21022020.pdf ).

Tytocare. New York: On Demand Medical Exams. Anytime. Anywhere (Accessed April 23, 2021, at https://www.tytocare.com. ).

DoCare. Bangkok: Smart Technology for Healthy Living. (Accessed April 23, 2021, at https://www.docareprotect.com. ).

Huawei Enterprise [Internet]. Bangkok: Huawei collaborative solution for COVID-19 (Accessed June 9, 2021, at https://e.huawei.com/th/solutions/enterprise-collaboration/videoconferencing-platform. ).

Capuzzo M. Costs of Intermediate Care and Intensive Care. ICU Manag Pract 2007;7(2):1-2. (Accessed June 9, 2021, at https://healthmanagement.org/c/icu/issuearticle/costs-ofintermediate-care-and-intensive-care )

Troughton R. Scaling Agile Trick Series: Mitosis [Internet]. Boston: 2017. (Accessed April 28, 2021, at http://www.agileforest.com/2017/05/11/scaling-agile-tricks-series-mitosis. ).

Ketphet K. Intensive care unit Scaling up and Utilization system. Training paper: Bangkok Hospital Headquarters, Bangkok. May 19, 2021.

Narayan S, Setlur R, Jahan N, et al. Planning a modular intensive care unit for patients of the COVID-19 pandemic. J Marine Med Soc 2020;22(3):51-6.

Ruthirago D. Treatment Guidance for Adult Critically ill Patients with COVID-19 by BHQ intensivists. Training paper: Bangkok Hospital Headquarters, Bangkok. April 30, 2021.

Charoengid W, Lumnoy N, Monwan A, et al. Nursing care for patients with covid-19 infection prevention course in Intermediate ICU. Training paper: Bangkok Hospital Headquarters, Bangkok. May 16, 2021.

World Health Organization. Regional Office for Europe. Integrated care models: an overview [Internet]. Geneva: 2021. (Accessed April 28, 2021, at https://www.euro.who.int/_data/assets/pdf_file/0005/322475 )

Wongsawang N, Patcheep K, ChooJai R, et al. Integrated approach of nursing process and humanized care for older adults nursing. Nurs J Public Health 2017;27(2):1-14.

Wongchaiya P, Ampansirirat A, Pinjai P. Patient-centered care: health care services for the 21st Century.

The Southern College Network. J Nurs Public Health 2017;4:s361-71.

Neto JMR, Viana RAPP, Franco SA, et al. Nursing diagnosis/ outcomes and interventions for critically ill patients affected by COVID-19 and sepsis. Texto Contexto Enferm [Internet]. 2020 [cited YEAR MONTH DAY]; 29: e20200160.

Thongngam S, Pumool S, Ratanarat R. Nursing care for patients with COVID-19 in the isolation unit, Siriraj Hospital. Siriraj Med Bull 2020;13(3):221-31.

Asghari E, Archibald M, Roshangar F. Nursing interventions for patients with COVID-19: A medical record review and nursing interventions classification study. Int J Nurs Knowl 2021:1-7.

Roca O, Caralt B, Messika J, et al. An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. Am J Resp Criti Care Med2019;199(11):1368-76.

Nishijima I, Oyadomari S, Maedomari S, et al. Use of a modified early warning score system to reduce the rate of in-hospital cardiac arrest. J Inten Care 2016;4(1):12. DOI: 10.1186/s40560-016-0134-7

Department of Medical Services. Ministry of Public Health. Hospital Risk Management Manual for Emerging Infectious Disease Epidemic [Internet]. Bangkok: 2021. (Accessed May 19, 2021, at

https://www.dmsic.moph.go.th/index/detail/8610 ).

World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak [Internet]. Geneva: 2021. (Accessed March 18, 2021, at

https://www.who.int/docs/default-source/coronavirus/mental-healthconsiderations.pdf )

Hossain MM, Sultana A, Purohit N. Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence. Epidemiol Health 2020;42(0):e2020038.

Bao Y, Sun Y, Meng S, et al. 2019-nCoV epidemic: address mental health care to empower society. Lancet 2020;395(10224):e37-8.

Al Dhaheri AS, Bataineh MF, Mohamad MN, et al. Impact of COVID-19 on mental health and quality of life: Is there any effect? A cross-sectional study of the MENA region. PloS One 2021;16(3):e0249107.

Penn State. Eberly College of Science. The Pennsylvania State University. statistical concepts and reasoning; confidence intervals for a population proportion [Internet]. Pennsylvania: 2021. (Accessed August 25, 2021, at https://online.stat.psu.edu/stat100/lesson/9/9.1 ).

Rees EM, Nightingale ES, Jafari Y, et al. COVID-19 length of hospital stay: a systematic review and data synthesis. BMC Med 2020;18(1):270.

Hamsen U, Lefering R, Fisahn C, et al. Workload and severity of illness of patients on intensive care units with available intermediate care units: a multicenter cohort study. Minerva Anestesiol 2018;84(8):938-45.

Lekwijit S, Chan CW, Green LV, et al. The impact of step-down unit care on patient outcomes after ICU discharge. Critical Care Explor 2020;2(5):e0114.

Vincent JL, Rubenfeld GD. Does intermediate care improve patient outcomes or reduce costs? Critical Care 2015;19(1):1-5.

Chaboyer W, James H, Kendall M. Transitional care after the intensive care unit: current trends and future directions. Critical Care Nurse 2005; 25(3):16-28.

Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health 2020;20:1193. doi.org/10.1186/ s12889-020-09301-4.