PURPOSE: Intensivists and “closed” intensive care units have been shown to reduce expenditures (Leap Frog). However, staffing shortages and cost of training have limited the number of intensivist-managed units to less than 5% as well as closed units to fewer than 25%. Several groups reported improved outcomes on transition to closed units but to date a study of concurrently operating open and closed units overseen by the same intensivists has not been published. We undertook the study of two newly built, coexisting units—one a traditional “open” ICU (faculty and non-faculty) and a second “closed” unit. We hypothesized that the “closed,” dedicated faculty intensivist-run unit would demonstrate improved utilization.
METHODS: A retrospective review of all admissions identified 445 medical patients admitted to the “closed” ICU and 569 to the “open” ICU. Pediatric, surgical and outlier patients were excluded. The primary outcomes were intensive care unit length of stay (ICU-LOS) and adjusted length of stay (ALOS). Secondary outcomes were “rollups” of in-hospital spending. For length of stay, data was log transformed and 2-tailed t-tests were applied. Age, ethnicity, consultation rates, and APRDRG severity did not differ significantly between intensive care units.
RESULTS: Initial ICU-LOS was 3.8 days for the “closed” unit and 4.5 days for the open unit (p<0.0001). ALOS was 12.1 for “closed” and 14.3 for “open.” (p value <0.02). Average pharmacy costs were $3045 and $4372 respectively (p< 0.001). Inhalational therapy costs were $1779 and $2881 (p <0.0001). Diagnostic imaging averaged $1810 and $2241 (p<.01). Clinical laboratory costs averaged $1382 and $1833 (p<.0001). Average hospital costs were $37,126 and $40,444 (p=0.17). Overall faculty case LOS was 10.3 versus 13.9 for non-faculty (p<0.0001).Consultation rates by faculty and non-faculty physicians were significantly different.
CONCLUSION: This study validates the efficiency of faculty intensivists in closed units. The combination of dedicated intensivists, presence on a faculty service, and a closed intensive care unit appeared to confer the greatest efficiency.
CLINICAL IMPLICATIONS: The findings support the concept of closed units run by dedicated, faculty intensivists.
DISCLOSURE: Dani Hackner, No Financial Disclosure Information; No Product/Research Disclosure Information