Effects of a closed ICU model on a general surgical ICU

Abstract

Introduction: A closed model of ICU care is associated with improved outcomes and less resource utilization in mixed medical and surgical ICUs as well as traumatic ICUs. However, most of our country ICUs use an open model, especially in surgical ICUs due to lack of specialized physicians. The aims of this study are to compare the effects of closed and open models on ICU mortality and length of ICU stay. Methods: We conducted a retrospective study to compare two periods of time that used an open model (July 2002 to June 2004; 1,038 patients) and a closed model (July 2004 to June 2006; 1,231 patients) on a single general surgical ICU in a university hospital. The closed model was defined as an ICU service led and managed by an intensivist. The open model was an ICU service in which critically ill surgical patients were managed by host surgeons individually. Results: A total of 2,269 patients were included in this study (open vs. closed; 1,038 vs. 1,231). The overall ICU mortality rate was decreased statistically significantly in the closed model (27.4% vs. 23.4%; P = 0.03). This effect was obvious in patients who were admitted to the ICU for more than 48 hours (22.7% vs. 13.9%; P <0.01). After adjusting for differences in baseline characteristics, the relative risk of death in a closed model ICU was 0.85 (0.74 to 0.98; P = 0.02) compared with the open model. The effect was explicit in patients admitted to the ICU for more than 48 hours (0.60 (0.47 to 0.76); P <0.01), in nontraumatic patients (0.81 (0.64 to 1.01)) and a trend toward to statistical significance in patients older than 65 years (0.81 (0.64 to 1.01); P = 0.07). In addition, the closed model ICU also decreased, the length of ICU stay (5.4 +/- 7.1 vs. 4.6 +/- 6.1 days; P <0.01) and the adjusted risk ratio was 0.45 (0.26 to 0.78; P