This review discusses the issues to be considered in establishing new or extending existing high dependency unit (HDU) services. A defined high dependency service becomes cost-effective when patient care requires more than one nurse for three patients. Professional guidelines for HDUs vary and there are no national accreditation criteria. Casemix and service delivery specifications for the HDU need to be defined and agreed upon within the institution. Establishing a new HDU service requires changes to care delivery. Many potential HDU patients are currently managed in general wards or in the intensive care unit. The service should be discussed widely and marketed within the institution, and the development of defined working relationships with the ICU and primary care teams on the wards is mandatory.
CamplingE.A., DevlinH.B., HoileR.W., LunnJ.N.The report of the national confidential inquiry into perioperative deaths 1991/1992.Department of Health, London1993
2.
HolcroftJ.W.Who should be responsible for the critically ill surgical patient?Arch Surg1990; 125: 1103–1104.
3.
RidleyS.A.Intermediate care. Possibilities, requirements and solutions.Anaesthesia1998; 53: 654–664.
4.
Guidelines on admission to and discharge from intensive care and high dependency units.Department of Health, London1996.
5.
The high dependency unit—acute care in the future.The Association of Anaesthetists for Great Britain and Ireland, London1991.
6.
Policy Document IC-13.Minimum standards for high dependency units seeking accreditation for training in intensive care.Faculty of Intensive Care, Australian and New Zealand College of Anaesthetists2000.
7.
PlantP.K., OwenJ.L., ElliottM.W.Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial.Lancet2000; 355: 1931–1935.
8.
Leeson-PayneC.G., AitkenheadA.R.A prospective study to assess the demand for a high dependency unit.Anaesthesia1995; 50: 385–387.
9.
Policy Document.IC-1 Minimum standards for intensive care units Faculty of Intensive Care, Australian and New Zealand College of Anaesthetists1997.
10.
FranklinC.M., RackowE.C., MamdaniB., NightingaleS., BurkeG., WeilM.H.Decreases in mortality on a large urban medical service by facilitating access to critical care. An alternative to rationing.Arch Intern Med1988; 148: 1403–1405.
11.
McClishD.K., RussoA., FranklinC., JacksonD.L., LewandowskiW., AlcoverI.Profile of medical ICU vs ward patients in an acute care hospital.Crit Care Med1985; 13: 381–386.
12.
GamilM., FanningA.The first 24 hours after surgery. A study of complications after 2153 consecutive operations.Anaesthesia1991; 46: 712–715.
13.
TurnerM., McFarlaneH.J., KrukowskiZ.H.Prospective study of high dependency care requirements and provision.J R Coll Surg Edinb1999; 44: 19–23.
14.
WallisC.B., DaviesH.T., ShearerA.J.Why do patients die on general wards after discharge from intensive care units?Anaesthesia1997; 52: 9–14.
15.
RudyE.B., DalyB.J., DouglasS., MontenegroH.D., SongR., DyerM.A.Patient outcomes of the chronically critically ill: special care unit vs intensive care unit.Nurs Res1995; 44: 324–331.
16.
PollackM.M., KatzR.W., RittimannU.E., GetsonP.R.Improving the outcome and efficiency of intensive care: the impact of an intensivist.Crit Care Med1988; 16: 11–17.
17.
HillmanK., BeehanS.Acute hospital medical staffing during the night shift.Aust Health Rev1998, 21: 163–173.
18.
BristowP.J., HillmanK.M., CheyT.Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team.Med J Aust2000; 173: 236–240.
LustbaderD., FeinA.Emerging trends in ICU management and staffing.Crit Care Clin2000; 16: 735–748.
23.
NehraD., CrumplinM.K.H., ValijanA., EdwardsA.E.Evolving role of intensive and high dependency care.Ann R Coll Surg Engl1994; 76: 9–16.
24.
CogginsR., ParkinC.H., De CossartL.Use of a general surgical high dependency unit in a district hospital: the first 10 years.J R Coll Surg Edinb1998; 43: 381–384.
25.
DhondG., RidleyS., PalmerM.The impact of a high dependency unit on workload of the intensive care unit.Anaesthesia1998; 53: 841–847.
26.
ThompsonH., SpiersP.Occupancy of a teaching hospital adult intensive care unit by high dependency patients.Anaesthesia1998; 53: 589–592.
27.
PeacockJ.E., EdbrookeD.L.Rationing intensive care. Data from one high dependency unit supports their effectiveness.BMJ1995; 310: 1413.
28.
ZimmermanJ.E., WagnerD.P., SunX., KnausW., DraperE.Planning patient services for intermediate care units: insights based on intensive care low risk monitor admissions.Crit Care Med1996; 24: 1626–1632.
29.
KilpatrickA., RidleyS., PlenderleithL.A changing role for intensive therapy: is there a case for high dependency care?Anaesthesia1994; 49: 666–670.
30.
GallimoreS.C., HoileR.W., IngramG.S., SherryK.M.The report of the national confidential inquiry into postoperative deaths 1994/1995.Department of Health, London1997.
31.
Medical Training Review Panel—Postgraduate Medical Councils.Commonwealth Government of Australia, 1999: 1–8.
32.
NewbleD.I., PagetN.S.The maintenance of professional standards programme of the Royal Australasian College of Physicians.J R Coll Physicians Lond1996; 30: 252–256.
33.
SaundersN.A., PagetN.S.Maintenance of professional standards and the recertification of physicians.J Intern Med1994; 236: 363–365.
34.
NasrawayS.A., CohenI.L., DennisR.C.Guidelines on admission and discharge for adult intermediate care units.Crit Care Med1998; 26: 607–610.
35.
HovengaE.J.S.An overview of the patient assessment and information system (PAIS), Faculty of Health Science, Central Queensland1994.
36.
EdbrookeD.L.The high dependency unit: where to now?Ann R Coll Surg Engl1996; 78: 161–162.
37.
HavillJ.H., CranstonD.The place of the high dependency unit in a modern New Zealand hospital.NZ Med J1998; 111: 203–205.
38.
ByrickR.J., MazerC.D.Caskennette GM. Closure of an intermediate care unit. Impact on critical care utilization.Chest1993; 104: 876–881.
39.
CogginsR., de CossartL.Improving post-operative care: the role of the surgeon in the high dependency unit.Ann R Coll Surg Engl1996; 78: 163–167.
40.
IvyM., AngoodP., KirtonO., ShapiroM., TishermanS., HorstM.Critical care medicine education for surgeons: recommendations from the Surgical Section of the Society of Critical Care Medicine.Crit Care Med2000; 28: 879–880.
41.
Care of the Critically Ill Surgical Patient.Royal Australasian College of Surgeons2000.
42.
KalbP.E., MillerD.H.Utilization strategies for intensive care units.JAMA1989; 261: 2389–2395.
43.
RidleyS.Critical Care Outcomes.Anaesthesia2001; 56: 1–3.
44.
VincentJ.L., BurchardiH.Do we need intermediate care units?Intensive Care Med1999; 25: 1345–1349.
45.
CogginsR.P.Delivery of surgical care in a district general hospital without high dependency facilities.Postgrad Med J2000; 76: 223–226.
