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