Intensive Care Medicine

, Volume 41, Issue 11, pp 1903–1910 | Cite as

Epidemiology of admissions to 11 stand-alone high-dependency care units in the UK

  • Meghan Prin
  • David Harrison
  • Kathryn Rowan
  • Hannah Wunsch



High-dependency care units (HDUs) are a focus of research to optimize critical care resource allocation. HDUs provide a level of care between the general ward and the intensive care unit (ICU). However, few data report on the case mix and outcomes of patients in these units.


Retrospective observational cohort study of patients admitted to 11 stand-alone HDUs in the UK from 2008 to 2011. We stratified patients by location prior to HDU admission and location on discharge from HDU, and we summarized the case mix, transitions of care, and mortality.


Of 9008 patients admitted to 11 stand-alone HDUs, 56.5 % were male and the mean age was 62.7 ± 17.9 years. The majority of patients admitted to HDUs were non-surgical (59.3 %), with 22.4 and 20.1 % admitted from the ICU and general ward, respectively; 41.3 % were admitted from the operating room or recovery suite. The median length of stay in HDU was 1.8 days (IQR 0.9–3.5) and in-HDU mortality was 5.1 %. Among HDU survivors (n = 8551), 8.5 % were discharged to an ICU, 80.9 % to a general ward, and 10.6 % to other care areas. For patients admitted to HDU from an ICU, only 5.8 % were readmitted to ICU. Hospital mortality for the HDU population was 14.8 %; for patients discharged to an ICU, hospital mortality was 43.6 %.


In a sample of 11 stand-alone HDUs in the UK, patients are from many different hospital locations. Hospital mortality for patients requiring HDU care is high, particularly for patients who require transfer to an ICU.


Intensive care Critical care Continuity of patient care Triage 



We would like to thank the Case Mix Programme staff at Intensive Care National Audit and Research Centre (ICNARC) for the use of these data.

Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


Award Number K08AG038477 from the National Institute on Aging to Hannah Wunsch.

Supplementary material

134_2015_4011_MOESM1_ESM.docx (163 kb)
Supplementary material 2 (DOCX 162 kb)


  1. 1.
    Chaboyer W, James H, Kendall M (2005) Transitional care after the intensive care unit: current trends and future directions. Crit Care Nurse 25:16–28PubMedGoogle Scholar
  2. 2.
    Beard H (2005) Does intermediate care minimize relocation stress for patients leaving the ICU? Nurs Crit Care 10:272–278CrossRefPubMedGoogle Scholar
  3. 3.
    Heller J, Murch P (2008) Development in service provision. Making major elective surgery happen. The development of a postoperative surgical unit. Nurs Crit Care 13:97–104CrossRefPubMedGoogle Scholar
  4. 4.
    Prin M, Wunsch H (2014) The role of stepdown beds in hospital care. Am J Respir Crit Care Med 190:1210–1216CrossRefPubMedGoogle Scholar
  5. 5.
    Wunsch H, Harrison DA, Jones A, Rowan K (2015) The impact of the organization of high-dependency care on acute hospital mortality and patient flow for critically ill patients. Am J Respir Crit Care Med 191:186–193CrossRefPubMedGoogle Scholar
  6. 6.
    Corrado A, Roussos C, Ambrosino N, Confalonieri M, Cuvelier A, Elliott M, Ferrer M, Gorini M, Gurkan O, Muir JF, Quareni L, Robert D, Rodenstein D, Rossi A, Schoenhofer B, Simonds AK, Strom K, Torres A, Zakynthinos S (2002) Respiratory intermediate care units: a European survey. Eur Respir J 20:1343–1350CrossRefPubMedGoogle Scholar
  7. 7.
    Capuzzo M, Volta C, Tassinati T, Moreno R, Valentin A, Guidet B, Iapichino G, Martin C, Perneger T, Combescure C, Poncet A, Rhodes A (2014) Hospital mortality of adults admitted to intensive care units in hospitals with and without intermediate care units: a multicentre European cohort study. Crit Care 18:551PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Harrison DA, Brady AR, Rowan K (2004) Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit and Research Centre Case Mix Programme Database. Crit Care 8:R99–111PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Department of Health (2000) Comprehensive critical care: a review of adult critical care services. Department of Health, London, p 37. Available at:
  10. 10.
    Padkin A, Goldfrad C, Brady AR, Young D, Black N, Rowan K (2003) Epidemiology of severe sepsis occurring in the first 24 h in intensive care units in England, Wales, and Northern Ireland. Crit Care Med 31:2332–2338CrossRefPubMedGoogle Scholar
  11. 11.
    Harrison DA, Welch CA, Eddleston JM (2006) The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996–2004: secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database. Crit Care 10:R42PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Harrison DA, Parry GJ, Carpenter JR, Short A, Rowan K (2007) A new risk prediction model for critical care: the Intensive Care National Audit and Research Centre (ICNARC) model. Crit Care Med 35:1091–1098CrossRefPubMedGoogle Scholar
  13. 13.
    Goldfrad C, Rowan K (2000) Consequences of discharges from intensive care at night. Lancet 355:1138–1142CrossRefPubMedGoogle Scholar
  14. 14.
    Renton J, Pilcher DV, Santamaria JD, Stow P, Bailey M, Hart G, Duke G (2011) Factors associated with increased risk of readmission to intensive care in Australia. Intensive Care Med 37:1800–1808CrossRefPubMedGoogle Scholar
  15. 15.
    Lilly CM, Zuckerman IH, Badawi O, Riker RR (2011) Benchmark data from more than 240,000 adults that reflect the current practice of critical care in the United States. Chest 140:1232–1242CrossRefPubMedGoogle Scholar
  16. 16.
    Chong JL, Pillai R, Fisher A, Grebenik C, Sinclair M, Westaby S (1992) Cardiac surgery: moving away from intensive care. Br Heart J 68:430–433PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Armstrong K, Young J, Hayburn A, Irish B, Nikoletti S (2003) Evaluating the impact of a new high dependency unit. Int J Nurs Pract 9:285–293CrossRefPubMedGoogle Scholar
  18. 18.
    Crosby DL, Rees GA (1983) Post operative care: the role of the high dependency unit. Ann R Coll Surg Engl 65:391–393PubMedCentralPubMedGoogle Scholar
  19. 19.
    Peacock JE, Edbrooke DL (1995) Rationing intensive care. Data from one high dependency unit supports their effectiveness. BMJ 310:1413PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Frieden J, Cooper JA (1976) The role of the intermediate cardiac care unit. JAMA 235:816–818CrossRefPubMedGoogle Scholar
  21. 21.
    Cady N, Mattes M, Burton S (1995) Reducing intensive care unit length of stay. A stepdown unit for first-day heart surgery patients. J Nurs Adm 25:29–35CrossRefPubMedGoogle Scholar
  22. 22.
    Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart G, Opdam H, Silvester W, Doolan L, Gutteridge G (2005) A before and after trial of the effect of a high-dependency unit on post-operative morbidity and mortality. Crit Care Resusc 7:16–21PubMedGoogle Scholar
  23. 23.
    Confalonieri M, Gorini M, Ambrosino N, Mollica C, Corrado A, Scientific Group on Respiratory Intensive Care of the Italian Association of Hospital P (2001) Respiratory intensive care units in Italy: a national census and prospective cohort study. Thorax 56:373–378PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Corrado A, Confalonieri M (1999) Respiratory high-dependency care units in Italy. Monaldi Arch Chest Dis 54:435–437PubMedGoogle Scholar
  25. 25.
    Junker C, Zimmerman JE, Alzola C, Draper EA, Wagner DP (2002) A multicenter description of intermediate-care patients: comparison with ICU low-risk monitor patients. Chest 121:1253–1261CrossRefPubMedGoogle Scholar
  26. 26.
    Wunsch H, Angus DC, Harrison DA, Linde-Zwirble WT, Rowan KM (2011) Comparison of medical admissions to intensive care units in the United States and United Kingdom. Am J Respir Crit Care Med 183:1666–1673CrossRefPubMedGoogle Scholar
  27. 27.
    Hutchings A, Durand MA, Grieve R, Harrison D, Rowan K, Green J, Cairns J, Black N (2009) Evaluation of modernisation of adult critical care services in England: time series and cost effectiveness analysis. BMJ 339:b4353PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Jones HJ, Coggins R, Lafuente J, de Cossart L (1999) Value of a surgical high-dependency unit. Br J Surg 86:1578–1582CrossRefPubMedGoogle Scholar
  29. 29.
    Jones DR, Copeland GP, de Cossart L (1992) Comparison of POSSUM with APACHE II for prediction of outcome from a surgical high-dependency unit. Br J Surg 79:1293–1296CrossRefPubMedGoogle Scholar
  30. 30.
    McIlroy DR, Coleman BD, Myles PS (2006) Outcomes following a shortage of high dependency unit beds for surgical patients. Anaesth Intensive Care 34:457–463PubMedGoogle Scholar
  31. 31.
    Byrick RJ, Power JD, Ycas JO, Brown KA (1986) Impact of an intermediate care area on ICU utilization after cardiac surgery. Crit Care Med 14:869–872CrossRefPubMedGoogle Scholar
  32. 32.
    Akkerman R, Knip M (2004) Reallocation of beds to reduce waiting time for cardiac surgery. Health Care Manag Sci 7:119–126CrossRefPubMedGoogle Scholar
  33. 33.
    Hilton G, Madayag M, Shagoury C (1993) Development of a surgical/trauma intermediate care unit. Clin Nurse Spec 7:274–279CrossRefPubMedGoogle Scholar
  34. 34.
    Lucena JF, Alegre F, Martinez-Urbistondo D, Landecho MF, Huerta A, Garcia-Mouriz A, Garcia N, Quiroga J (2013) Performance of SAPS II and SAPS 3 in intermediate care. PLoS One 8:e77229PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Ip SP, Leung YF, Ip CY, Mak WP (1999) Outcomes of critically ill elderly patients: is high-dependency care for geriatric patients worthwhile? Crit Care Med 27:2351–2357CrossRefPubMedGoogle Scholar
  36. 36.
    Alegre F, Landecho MF, Huerta A, Fernandez-Ros N, Martinez-Urbistondo D, Garcia N, Quiroga J, Lucena JF (2015) Design and performance of a new severity score for intermediate care. PLoS One 10:e0130989PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Boots R, Lipman J (2002) High dependency units: issues to consider in their planning. Anaesth Intensive Care 30:348–354PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Meghan Prin
    • 1
  • David Harrison
    • 2
  • Kathryn Rowan
    • 2
  • Hannah Wunsch
    • 1
    • 3
    • 4
  1. 1.Department of AnesthesiologyColumbia UniversityNew YorkUSA
  2. 2.Intensive Care National Audit and Research CentreLondonUK
  3. 3.Department of Critical Care MedicineSunnybrook Health Sciences Centre and Sunnybrook Research InstituteTorontoCanada
  4. 4.Department of AnesthesiologyUniversity of TorontoTorontoCanada

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