Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE

18 Maternal Intensive Care in Belgium KCE Reports 94
• Care of postpartum conditions;
• Resuscitation and stabilisation of all neonates born in the hospital;
• Evaluation and continuing care of healthy neonates in a nursery or with their
mothers until discharge;
• Adequate nursery facilities and support for stabilisation of small or ill
neonates before transfer to a specialty of subspecialty facility;
• Consultation and transfer arrangements;
• Parent-sibling-neonate visitation;
• Data collection and retrieval.
Some basic care facilities may provide continuing care for neonates who have minor
problems. Many basic care facilities provide care for convalescing neonates who have
been transferred from specialty and subspecialty facilities.
C. Intermediate Care
INTRODUCTION
Health care organisations around the globe need to cope with a rising demand for care,
scientific evolutions (evidence based), the increasing costs and limited budgets, limited
beds, insufficient medical and paramedical personnel. These restrictions stimulate health
care managers and policymakers to reorganise their healthcare services more efficiently.
An example of a ‘new’ health care structure is the ‘graded care’ structure 11, 12 . Beside
the already existing general ward and ICU, another structure was introduced: the
intermediate care service. These intermediate care units (also termed high-dependency
or step-up/step-down units) have generally a higher nurse/patient ratio and more
facilities for intensive monitoring than a general ward, but fewer staff and less invasive
equipment than on an ICU. This facility is required for patients too sick for care on a
general ward, to step up to care intermediate between that on a general ward and the
ICU, and for others appropriate to step down from ICU to a general ward. Such areas
cater for patients who do not require full ICU care but are thought to need more care
than could be offered on the general ward.
Intermediate care services have been adopted by some hospitals, for specific patient
groups e.g. paediatrics, obstetrics. The use of these services is promoted to enable
earlier discharge of some ICU patients and to provide an alternative to intensive care
and thus freeing ICU-beds. There are few, if any prospective studies on the benefits of
intensive versus intermediate care which provide objective and hence comparable
admission and discharge criteria 13 .
Our systematic literature review did not result in a consensus definition of obstetric
intermediate care (~MIC). Variation within the definitions used is due to large
differences between the organisational structures of the individual perinatal care
settings. Therefore, we decided to integrate several definitions into a self-constructed
definition applicable to the Belgian MIC-context (see conclusion of this chapter). The
underneath paragraphs give an overview of the most relevant definitions that served as
a basis for our own definition. The American guidelines of perinatal care and the article
from Lee and colleagues 7 are mentioned separately as they acted as a point of
reference.
GENERAL INTERMEDIATE CARE DEFINITIONS
Nasraway 14 identified in their ‘Guidelines on admission and discharge for adult
intermediate care services’ a patient population that does not require intensive care but
needs more care than that provided on a general ward. These patients may require
frequent monitoring of vital signs and/or nursing interventions, but usually do not
require invasive monitoring.