Evaluation of the Methods and Effectiveness of Care for Eligible Medical and Surgical Patients on Admission in Continuous Monitoring Units
Condition: Units Continuous Monitoring (USC)
Study type: Observational

Summary: 
      In France, Intensive Medicine is carried out in three types of structures: intensive care
      units, intensive care unit and units Continuous Monitoring (USC). Created in the 90s as
      intermediate structures between conventional care units and intensive care units, these units
      are assigned to the care of patients whose conditions and treatment are fear the occurrence
      of one or more critical failures requiring to be monitored, or whose condition, at the end of
      one or more critical failure is too severe or unstable to allow a return to a classical
      inpatient unit.

      Thus, USC represent a milestone in the journey of patients whose condition is critical:
      patients from the emergency services, patients in the immediate postoperative period, coming
      out of intensive care patients, or finally in conventional hospitalization patients whose
      condition s 'worse. The creation of the USC is not subject to authorization but must be
      contractualized between the hospital and the Regional Health Agency (ARS) because it is
      resource intensive. Organizations and their operating modes are guided by the recommendations
      of the French Society of Anesthesia and Intensive Care (SFAR), and the Society of French
      Language Resuscitation (SRLF) published in 2005.The US establishment has a beneficial effect
      on the quality of care and the care pathway of patients at risk shown by the reduction in
      morbidity and mortality, the rate of admission and / or USC readmission of length of stay and
      hospital stay costs.

      It is possible to objectify provided first establish an inventory on the activity of these
      units and the patient base supported. To judge the benefit of the assumption by the USC, it
      is necessary to assess the adequacy of patients managed with an updated specification and
      defined by a group of experts.
    

Detailed description: 
      4600 adult patients will be enrolled in the study with the primary objective to quantify in
      terms of mortality reduction, "the benefit" of using USC on the effectiveness of the
      treatment and patient care pathway that present Medical eligibility criteria to supervision
      USC.

      The methodology of the study is organized into 5 phases:

        -  Development of candidate criteria that justify the presence in USC and validation by a
           panel of experts according to the Delphi method

        -  Selection of a representative sample of 100 institutions with USC stratified by major
           regions (North, Ile-de-France, Southeast, Southwest), the activity of the USC (number
           admissions / year), method of financing the establishment, presence or absence of an
           operating theater.

        -  Observational Cohort study, prospective, multicenter. In each selected center will be
           collected the data during consecutive patients 1-2 weeks depending on the activity
           centers on USC sectors, post-operative, post-resuscitation and post emergency. Data
           collection will be done on the ground and from Medicalization Programme of Information
           Systems extraction . An external quality control will be organized on 10% of stays.

        -  Determination of eligibility for hospitalization USC will be conducted by a group of
           professionals representing different companies analysis in pairs and independently
           stays.

        -  Modelling and economic evaluation: development and validation of the score (ASIC
           Activity Score for Intermediate Care) and medico-economic analysis.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The study population will be one of the selected schools and hospitals among those with a
        USC.