PURPOSE:Research has shown that closed Intensive Care Unit (ICU) systems can improve patient outcomes, decrease length of ICU stays, and improve financial implications for institutions. Our hospital transitioned from an open to closed medical ICU system July 1, 2007. Our goal was to examine the association of this change on a range of clinical outcomes.
METHODS:Chart reviews were performed for all patients admitted to the medical ICU in the months of May and June of 2006 and 2007. We compared the number of admissions, length of stay, Acute Physiology And Chronic Health Evaluation (APACHE) II scores, number and locations of central lines, number of arterial lines, need for and length of intubation, need for reintubation, and 30-day mortality. Independent samples t-tests were used to compare continuous outcomes and Chi-square analyses were used for categorical outcomes.
RESULTS:141 patients were admitted during the open period versus 152 in the closed period. When compared to the open model, the patients in the closed model had: more central lines placed (0.5 versus 0.3; p=0.001) with a lower rate of femoral line placement, more arterial lines placed (0.3 versus 0.1; p=0.001), and less reintubation (0 versus 4; p=0.017). Patients admitted in the closed system showed trends toward higher APACHE II scores (13.9 versus 12.4; p=0.123), and shortened length of stay (4.2 versus 4.8 days; p=0.348). No significant difference in survival was noted between open and closed models (91.2% versus 88.2% respectively; p=.391).
CONCLUSION:Transition to a closed ICU system was associated with more central and arterial lines placed and lower rates of re-intubation. Trends toward increasing severity of illness and shortened length of stay were observed.
CLINICAL IMPLICATIONS:Transition from an open to a closed medical ICU model may result in improved monitoring via central and arterial line placement and possibly shortened length of stays.
DISCLOSURE:Nichole Clark, No Financial Disclosure Information; No Product/Research Disclosure Information