European Mortality & Length Of Intensive Care Unit (ICU) Stay Evaluation (ELOISE)

Despite the high cost of Intensive Care Unit (ICU), a significant number of patients surviving intensive care die subsequently in hospital after the transfer to ward. Mortality rates after discharge from ICU have been reported to range from 6.1 to 27%

In 2000, it was reported that premature discharge from ICU was more likely to occur at night and was associated with higher death rates. Suggested factors that might account for a worse outcome for night discharges were poorer quantity and quality of care available at night both during transfer and at the destination. The implication of this study for the health system was that many hospitals did not have enough ICU beds. To facilitate earlier ICU discharges of ICU patients who are thought to need more care than those which can be provided on wards, InterMediate Care Units (IMCU) with level of nursing staff (and costs) lower than ICU were proposed more than a decade ago.

Despite the relevance of the topic, the literature on the efficacy and cost-effectiveness of IMCU available at present shows variable results. And the potential benefits of IMCUs remain uncertain.

The most striking are probably the following questions:

• Does IMCU decrease the hospital mortality rate of ICU patients?
• Does IMCU allow earlier ICU discharge and hence improve patients flux through the ICU and reduce ICU cost?
• Does IMCU permit a reduction of ICU readmissions? We propose to address these issues in a large multinational, multicentre study.

Inclusion criteria

• admission to one of the Study Unit
• any organ support allowed
• age of at least 16 years

Exclusion criteria

• age lower than 16 years
• patients admitted as donor for transplant
• patients admitted with limitation of care stated before admission