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Original Research: CRITICAL CARE MEDICINE |

Relationship Between ICU Design and Mortality

David E. Leaf, MD; Peter Homel, PhD; Phillip H. Factor, DO, FCCP
Author and Funding Information

From the Department of Medicine (Dr Leaf), Columbia University College of Physicians and Surgeons; the Department of Biostatistics (Dr Homel) and the Division of Pulmonary, Critical Care, and Sleep Medicine (Dr Factor), Beth Israel Medical Center, and Albert Einstein College of Medicine (Dr Factor); New York, NY.

Correspondence to: Phillip H. Factor, DO, 7 Dazian, Beth Israel Hospital, 1st Ave at 16th St, New York, NY 10003; e-mail: pfactor@chpnet.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(5):1022-1027. doi:10.1378/chest.09-1458
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Background:  Architectural design of health-care facilities can influence patient safety; however, it is unknown whether patient outcomes are significantly affected by ICU design.

Methods:  Six hundred sixty-four patients admitted to the medical ICU (MICU) of Columbia University Medical Center during 2008 were included in this retrospective study. Patient outcome measures, which included hospital mortality, ICU mortality, ICU length of stay (LOS), and ventilator-free days, were compared based on random room assignment. Rooms that were not visible from the MICU central nursing station were designated as low-visible rooms (LVRs), whereas the remaining rooms were designated as high-visible rooms (HVRs).

Results:  Overall hospital mortality did not differ among patients assigned to LVRs vs HVRs; however, severely ill patients (those with Acute Physiology and Chronic Health Evaluation II scores > 30) had significantly higher hospital mortality when admitted to an LVR than did similarly ill patients admitted to an HVR (82.1% and 64.0%, n = 39 and 75, respectively; P = .046). ICU mortality showed a similar pattern. ICU LOS and ventilator-free days did not differ significantly between groups.

Conclusions:  Severely ill patients may experience higher mortality rates when assigned to ICU rooms that are poorly visualized by nursing staff and physicians.

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