A 'Closed' Medical Intensive Care Unit (MICU) Improves Resource Utilization When Compared with an 'Open' MICU
| Autor: | Steven M. Scharf, Alan S. Multz, Alan M. Fein, Israel M. Samson, David R. Dantzker, Harry Steinberg, Michael S. Niederman, Donald B. Chalfin |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Resuscitation medicine.medical_specialty Pediatrics Adolescent Critical Care health care facilities manpower and services medicine.medical_treatment Critical Care and Intensive Care Medicine Severity of Illness Index law.invention Patient Admission law Severity of illness Odds Ratio medicine Humans Prospective Studies Prospective cohort study Aged Retrospective Studies Aged 80 and over Mechanical ventilation business.industry Retrospective cohort study Odds ratio Length of Stay Middle Aged Respiration Artificial Intensive care unit Intensive Care Units Emergency medicine Health Resources Medicine Female business Resource utilization Specialization |
| Zdroj: | American Journal of Respiratory and Critical Care Medicine. 157:1468-1473 |
| ISSN: | 1535-4970 1073-449X |
| DOI: | 10.1164/ajrccm.157.5.9708039 |
| Popis: | We hypothesized that a "closed" intensive care unit (ICU) was more efficient that an "open" one. ICU admissions were retrospectively analyzed before and after ICU closure at one hospital; prospective analysis in that ICU with an open ICU nearby was done. Illness severity was gauged by the Mortality Prediction Model (MPM0). Outcomes included mortality, ICU length of stay (LOS), hospital LOS, and mechanical ventilation (MV). There were no differences in age, MPM0, and use of MV. ICU and hospital LOS were lower when "closed" (ICU LOS: prospective 6.1 versus 12.6 d, p < 0.0001; retrospective 6.1 versus 9.3 d, p < 0.05; hospital LOS: prospective 19.2 versus 33.2 d, p < 0.008; retrospective 22.2 versus 31.2 d, p < 0.02). Days on MV were lower when "closed" (prospective 2.3 versus 8.5 d, p < 0.0005; retrospective 3.3 versus 6.4 d, p < 0.05). Pooled data revealed the following: MV predicted ICU LOS; ICU organization and MPM0 predicted days on MV; MV and ICU organization predicted hospital LOS; mortality predictors were open ICU (odds ratio [OR] 1.5, p < 0.04), MPM0 (OR 1.16 for MPM0 increase 0.1, p < 0.002), and MV (OR 2.43, p < 0.0001). We conclude that patient care is more efficient with a closed ICU, and that mortality is not adversely affected. |
| Databáze: | OpenAIRE |
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