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Critical Care |

Impact of Two Different Models of Intensive Care Unit Care on Infectious Complications in a Tertiary Care Center

Karim El-Kersh, MD; Jesse Roman, MD; Rodrigo Cavallazzi, MD; Juan Guardiola, MD; Timothy Wiemken, PhD; James Ketterhagen, MD; Mohamed Saad, MD
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University of Louisville, Louisville, KY


Chest. 2015;148(4_MeetingAbstracts):247A. doi:10.1378/chest.2269469
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Abstract

SESSION TITLE: Critical Care Posters III

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Tertiary centers continue to evaluate models of care in intensive care units in an attempt to provide high quality care while decreasing costs. This project aimed to examine the impact of implementing 2 different models of intensive care unit (ICU) care in a tertiary care center on infectious complications in critically ill patients.

METHODS: Retrospective data analysis was performed to examine rates of ventilator-associated pneumonia (VAP) and central line-associated blood stream infection (CLABSI) in a tertiary care center under two different models of ICU care in two consecutive years. In 2011, patients were cared under an open ICU model (open model) with a mandatory intensive care consult to one of two teams; the first team included private critical care physicians while the second team included academic critical care team. In 2012, the ICU model was a closed ICU (closed model) led by the academic critical care team with implementation of daily multidisciplinary quality rounds and protocolized care.R version 3.1 was used for all the analyses. P-values of <0.05 were considered statistically significant.

RESULTS: When outcomes in the closed model were compared to those in the open model, there was a reduction of 52% in the VAP rate (21.52/1000 ventilator days vs. 10.28/1000 ventilator days; p = 0.038). Also, there was a 25% reduction in CLABSI rate (3.6/1000 central line days in 2011 vs. 2.7/1000 central line days in 2012), but this was not statistically significant (p = 0.631).

CONCLUSIONS: A closed ICU model led by a single team of critical care specialists, pulmonary/critical care fellows, and nurse practitioners delivering protocolized care can reduce rates of ICU acquired infections including VAP and CLABSI.

CLINICAL IMPLICATIONS: ICU-acquired infections are associated with higher morbidity, mortality, and increased health care utilization. Up to 1/3 of critically ill patients develop infectious complications during delivery of care in the ICU. Prior studies showed improved outcomes of critically ill patients via application of protocolized care. Furthermore, a closed ICU model was shown to be associated with more efficient use of VAP and CLABSI best practices. Our findings add to the growing evidence that delivery of protocolized care in a closed unit model can improve infectious complications in the critically ill patients. We speculate that a closed ICU model allows clinical leadership centralization which further facilitates standardized care delivery that translates into less infectious complications.

DISCLOSURE: The following authors have nothing to disclose: Karim El-Kersh, Jesse Roman, Rodrigo Cavallazzi, Juan Guardiola, Timothy Wiemken, James Ketterhagen, Mohamed Saad

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