Impact of staffing model conversion from a mandatory critical care consultation model to a closed unit model in the medical intensive care unit

Abstract

Background The intensive care unit (ICU) staffing model affects clinical outcomes of critically ill patients. However, the benefits of a closed unit model have not been extensively compared to those of a mandatory critical care consultation model. Methods This retrospective before-after study included patients admitted to the medical ICU. Anthropometric data, admission reason, Acute Physiology and Chronic Health Evaluation II score, Eastern Cooperative Oncology Group grade, survival status, length of stay (LOS) in the ICU, duration of mechanical ventilator care, and occurrence of ventilator-associated pneumonia (VAP) were recorded. The staffing model of the medical ICU was changed from a mandatory critical care consultation model to a closed unit model in September 2017, and indices before and after the conversion were compared. Results A total of 1,526 patients were included in the analysis. The mean age was 64.5 years, and 954 (62.5%) patients were men. The mean LOS in the ICU among survivors was shorter in the closed unit model than in the mandatory critical care consultation model by multiple regression analysis (5.5 vs. 6.7 days; p = 0.005). Central venous catheter insertion (38.5% vs. 51.9%; p < 0.001) and VAP (3.5% vs. 8.6%; p < 0.001) were less frequent in the closed unit model group than in the mandatory critical care consultation model group. After adjusting for confounders, the closed unit model group had decreased ICU mortality (adjusted odds ratio 0.65; p < 0.001) and shortened LOS in the ICU compared to the mandatory critical care consultation model group. Conclusion The closed unit model was superior to the mandatory critical care consultation model in terms of ICU mortality and LOS among ICU survivors.

Excellence of the closed intensive care unit system in critically ill surgical patients

“…To our knowledge, our study is the first in Korea to explore the effects of the CSICU system. We found that the CSICU system led by intensivists exerts a positive impact on patients' prognosis and ICU operation [10][11][12][13][14][15]. This study chronologically investigated the effect of the application of the CSICU system on the clinical outcome of only surgical patients to confirm its usefulness in the surgical ICU.…”

“…Intensivists are advantageous for the management of critically ill patients due to their high understanding of the pathophysiology of critically ill patients, evidence-based management, use of systematic treatment protocols, and high proficiency in high-level treatments such as CRRT and mechanical ventilation. Therefore, there are several reports that the closed ICU system in which the intensivist completely manages critically ill patients improves the clinical outcome of these patients [10][11][12][13][14][15]. However, despite these positive reports, a truly closed ICU system, which is managed by the ICU staff composed of intensivists, has not been widely established around the world.…”

Causes and Outcomes of Intensive Care Admission Refusals: A Retrospective Audit from a Rural Teaching Hospital in Eastern Cape, South Africa

“…At the same time, the primary care physician, such as a surgeon, internal medicine doctor, or family doctor, retains overall responsibility for the patient admitted to the ICU. Scientific evidence indicates that closed units may yield better survival rates than open ones [ 7 , 8 ]. However, in South Africa, only 7% of public units and less than 1% of private units were reported to be “ideal closed units” in 2007 [ 9 ].…”