Highlights
- •Impact of surgical ICU modeling on trauma surgical patient outcomes.
- •Compared to an open model, a closed-collaborative SICU model provides.
- oEquivalent care (mortality and complications) despite having sicker patients.
- oSignificant reduction in ICU LOS in the sickest cohort of patients (ISS ≥15).
- oNonstatistically significant reduction in ICU charges in the sickest cohort of patients (ISS ≥15).
- o
Abstract
Introduction
The optimization of intensive care unit (ICU) care impacts clinical outcomes and resource
utilization. In 2017, our surgical ICU (SICU) adopted a “closed-collaborative” model.
The aim of this study is to compare patient outcomes in the closed-collaborative model
versus the previous open model in a cohort of trauma surgical patients admitted to our adult
level 1 trauma center.
Methods
A retrospective review of trauma patients in the SICU from August 1, 2015 to July
31, 2019 was performed. Patients were divided into those admitted prior to August
1, 2017 (the “open” cohort) and those admitted after August 1, 2017 (the “closed-collaborative”
cohort). Demographic variables and clinical outcomes were analyzed. Trauma severity
was assessed using injury severity score (ISS).
Results
We identified 1669 patients (O: 895; C: 774). While no differences in demographics
were observed, the closed-collaborative cohort had a higher overall ISS (O: 21.5 ± 12.14;
C: 25.10 ± 2.72; P < 0.0001). There were no significant differences between the two cohorts in the incidence
of strokes (O: 1.90%; C: 2.58%, P = 0.3435), pulmonary embolism (O: 0.78%; C: 0.65%; P = 0.7427), sepsis (O: 5.25%; C: 7.49%; P = 0.0599), median ICU charges (O: $7784.50; C: $8986.53; P = 0.5286), mortality (O: 11.40%; C: 13.18%; P = 0.2678), or ICU length of stay (LOS) (O: 4.85 ± 6.23; C: 4.37 ± 4.94; P = 0.0795).
Conclusions
Patients in the closed-collaborative cohort had similar clinical outcomes despite
having a sicker cohort of patients. We hypothesize that the closed-collaborative ICU
model was able to maintain equivalent outcomes due to the dedicated multidisciplinary
critical care team caring for these patients. Further research is warranted to determine
the optimal model of ICU care for trauma patients.
Keywords
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B. K. LaFerney, H. Jensen, R. Reif, J. Bennett, M. K. Kimbrough. Closed surgical intensive care unit organization improves cardiothoracic surgical patient outcomes. Conference abstract, presented at the Academic Surgical Congress on February 6, 2020, by Brianna LaFerney, abstract number ASC20201707.
Article info
Publication history
Published online: November 24, 2022
Accepted:
November 6,
2022
Received in revised form:
October 23,
2022
Received:
March 2,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
