To compare the effect on clinical outcome of changing a surgical intensive care unit from an open to a closed unit.
Design The study was carried out at a surgical intensive care unit in a large tertiary care hospital, which was changed on January 1,1996, from an open unit, where private attending physicians contributed and controlled the care of their patients, to a closed unit, where patients'medical care was provided only by the surgical critical care team (ABS or ABA board-certified intensivists).
A retrospective review was undertaken over 6 consecutive months in each system, encompassing 274 patients (125 in the open-unit period, 149 in the closed-unit period).
Morbidity and mortality were compared between the two periods, along with length-of-stay (LOS) and number of consults obtained.
A set of independent variables was also evaluated, including age, gender, APACHE III scores, the presence of preexisting medical conditions, the use of invasive monitoring (Swan-Ganz catheters, central and arterial lines), and the use of antibiotics, low-dose dopamine (LDD) for renal protection, vasopressors, TPN, and enteral feeding.
Mortality (14.4% vs. 6.04%, p=0.012) and the overall complication rate (55.84% vs. 44.14%, p=0.002) were higher in the open-unit group versus the closed-unit group, respectively.
The number of consults obtained was decreased (0.6 vs. 0.4 per patient, p=0.036), and the rate of occurrence of renal failure was higher in the open-unit group (12.8% vs. 2. (...)
Mots-clés Pascal : Etats Unis, Amérique du Nord, Amérique, Homme, Organisation hospitalière, Chirurgie, Unité soin intensif, Service hospitalier, Milieu confiné, Milieu dispersé, Evaluation, Mortalité, Complication
Mots-clés Pascal anglais : United States, North America, America, Human, Hospital organization, Surgery, Intensive care unit, Hospital ward, Confined space, Dispersed medium, Evaluation, Mortality, Complication
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0152115
Code Inist : 002B25N. Création : 16/11/1999.