PURPOSE: The purpose of this study is to evaluate the effect on clinical outcomes of changing a mixed surgical intensive care unit (ICU) from an open system to a combined-care system, in which patients’ care was provided collaboratively by the original surgeon and a unit-based intensivist.
METHODS: The study was carried out at a mixed surgical ICU in a medical center in Taiwan. The physician staffing pattern was changed on August 1, 2007, from an open system to a combined-care system. Daily round with the intensivist and weekly conference attended by all ICU staffs were launched since that time. A retrospective analysis was undertaken over 17 consecutive months in open system and 24 months in combined-care system. ICU mortality and ICU LOS were compared between the two periods. A set of variables was also evaluated, including age, Acute Physiology and Chronic Health Evaluation Score (APACHE II) and use of mechanical ventilation at ICU admission, surgical subspecialties, and proportion of scheduled operation.
RESULTS: After excluding patients younger than 18 year-old and experiencing inter-ICU transfer, 1976 patients were included in this study. Although patients admitted after conversion of physician staffing pattern have significantly higher APACHE II scores (14.49±8.31 vs. 16.65±8.39, p< 0.0001), ICU mortality rates are similar between these two groups(10.87% vs. 11.48%, p=0.677). A trend toward shorter ICU LOS is observed (6.00±11.14 vs. 5.41±7.87, p=0.197) after the conversion to combined-care system. In further subgroup analysis according to subspecialties, patients admitted due to cardiovascular surgical problems have significantly shorter ICU LOS (5.71±12.58 vs. 3.68±4.24, p=0.045) after conversion to combined-care system.
CONCLUSION: The conversion from open-system to combined-care system can reduce ICU length of stay in patients with cardiovascular problems in a mixed surgical ICU.
CLINICAL IMPLICATIONS: Intensivist-led collaborative care system should be considered in cardiovascular surgical ICUs because of enhanced resource utilization and reduced ICU length of stay.
DISCLOSURE: Min-Hsin Huang, No Financial Disclosure Information; No Product/Research Disclosure Information