Intermediate Care Unit performance being properly assessed?

Intermediate Care Units (ImCU) are worldwide considered as an intermediate setting of care between standard wards and intensive care units (ICU), specifically addressed to critically ill patients admitted from Emergency Departments, stepping down from ICUs or stepping up from general wards. ImCU formats vary considerably between institutions, missing univocal criteria of where they should be placed, how be formatted and staffed, what monitoring and treatments delivered, which patients admitted, and when discharged. Many published studies focused primarily on mortality as the main variable of interest, while the effects of ImCU implementations on healthcare costs, hospital governance and comprehensive inpatient outcomes remain controversial. A consensus on which measures should be most accurate and based on evidence is still lacking. Appropriate quality-of-care key indicators should concern structures, processes, outcomes and their relationships. The development of a multi-level framework to assess ImCU performance, tailored on resources and management of each specific reality, should consider their functional role on hospital macro-systems, warranting both by patient-level and system-level objectives to ensure effective benchmarking and to provide a substantial support to clinical practice.