The impact of open versus closed format ICU admission practices on the outcome of high risk surgical patients: a cohort analysis
Open Access
- 23 August 2011
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Surgery
- Vol. 11 (1), 18
- https://doi.org/10.1186/1471-2482-11-18
Abstract
Background In the year 2000, the organizational structure of the ICU in the Zaandam Medical Centre (ZMC) changed from an open to a closed format ICU. The objective of this study was to evaluate the effect of this organizational change on outcome in high risk surgical patients. Methods The medical records of all consecutive high risk surgical patients admitted to the ICU from 1996 to 1998 (open format) and from 2003 to 2005 (closed format), were reviewed. High-risk patients were defined according to the Identification of Risk in Surgical patients (IRIS) score. Parameters studied were: mortality, morbidity, ICU length of stay (LOS) and hospital LOS. Results Mortality of ICU patients was 25.7% in the open format group and 15.8% in the closed format group (p = 0.01). Morbidity decreased from 48.6% to 46.1% (p = 0.6). The average length of hospital stay was 17 days in the open format group, and 21 days in the closed format group (p = 0.03). Conclusions High risk surgical patients in the ICU are patients that have undergone complex and often extensive surgery. These patients are in need of specialized treatment and careful monitoring for maximum safety and optimal care. Our results suggest that closed format is a more favourable setting than open format to minimize the effects of high risk surgery, and to warrant safe outcome in this patient group.Keywords
This publication has 20 references indexed in Scilit:
- Risk modelling of outcome after general and trauma surgery (the IRIS score)British Journal of Surgery, 2009
- Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: An alternative paradigm for intensivist staffing*Critical Care Medicine, 2004
- [Intensive care medicine in the Netherlands, 1997-2001. II. Changes over time and differences between hospitals].2003
- Physician Staffing Patterns and Clinical Outcomes in Critically Ill PatientsJAMA, 2002
- Goal-directed Intraoperative Fluid Administration Reduces Length of Hospital Stay after Major SurgeryAnesthesiology, 2002
- Multimodal strategies to improve surgical outcomeThe American Journal of Surgery, 2002
- Intensive care unit nurse staffing and the risk for complications after abdominal aortic surgery.2001
- The impact of organisational change on outcome in an intensive care unit in the United Kingdom.Intensive Care Medicine, 2001
- Intensive care unit physician staffing is associated with decreased length of stay, hospital cost, and complications after esophageal resectionCritical Care Medicine, 2001
- Intensive care unit telemedicine: Alternate paradigm for providing continuous intensivist careCritical Care Medicine, 2000