Closed Collaborative Surgical Intensive Care Unit Modeling and Its Association With Trauma Patient Outcomes

Published:November 24, 2022DOI:


      • Impact of surgical ICU modeling on trauma surgical patient outcomes.
      • Compared to an open model, a closed-collaborative SICU model provides.
        • o
          Equivalent care (mortality and complications) despite having sicker patients.
        • o
          Significant reduction in ICU LOS in the sickest cohort of patients (ISS ≥15).
        • o
          Nonstatistically significant reduction in ICU charges in the sickest cohort of patients (ISS ≥15).



      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.


      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).


      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).


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Yang Q.
        • Du J.L.
        • Shao F.
        Mortality rate and other clinical features observed in Open vs closed format intensive care units: a systematic review and meta-analysis.
        Medicine (Baltimore). 2019; 98: e16261
        • Multz A.S.
        • Chalfin D.B.
        • Samson I.M.
        • et al.
        A “closed” medical intensive care unit (MICU) improves resource utilization when compared with an “open” MICU.
        Am J Respir Crit Care Med. 1998; 157: 1468-1473
        • Carson S.S.
        • Stocking C.
        • Podsadecki T.
        • et al.
        Effects of organizational change in the medical intensive care unit of a teaching hospital: a comparison of ‘open’ and ‘closed’ formats.
        JAMA. 1996; 276: 322-328
        • Durbin Jr., C.G.
        Team model: advocating for the optimal method of care delivery in the intensive care unit.
        Crit Care Med. 2006; 34: S12-S17
        • Chittawatanarat K.
        • Pamorsinlapathum T.
        The impact of closed ICU model on mortality in general surgical intensive care unit.
        J Med Assoc Thai. 2009; 92: 1627-1634
        • Nathens A.B.
        • Rivara F.P.
        • MacKenzie E.J.
        • et al.
        The impact of an intensivist-model ICU on trauma-related mortality.
        Ann Surg. 2006; 244: 545-554
        • le Cessie S.
        • Goeman J.J.
        • Dekkers O.M.
        Who is afraid of non-normal data? Choosing between parametric and non-parametric tests.
        Eur J Endocrinol. 2020; 182: E1-E3
        • Moore L.
        • Stelfox H.T.
        • Turgeon A.F.
        • et al.
        Hospital length of stay after admission for traumatic injury in Canada: a multicenter cohort study.
        Ann Surg. 2014; 260: 179-187
        • Schoenfeld A.J.
        • Belmont Jr., P.J.
        • See A.A.
        • Bader J.O.
        • Bono C.M.
        Patient demographics, insurance status, race, and ethnicity as predictors of morbidity and mortality after spine trauma: a study using the National Trauma Data Bank.
        Spine J. 2013; 13: 1766-1773
        • Stricker K.
        • Rothen H.U.
        • Takala J.
        Resource use in the ICU: short- vs. long-term patients.
        Acta Anaesthesiol Scand. 2003; 47: 508-515
        • DiMaggio C.
        • Ayoung-Chee P.
        • Shinseki M.
        • et al.
        Traumatic injury in the United States: in-patient epidemiology 2000-2011.
        Injury. 2016; 47: 1393-1403
        • Matsushima K.
        • Goldwasser E.R.
        • Schaefer E.W.
        • Armen S.B.
        • Indeck M.C.
        The impact of intensivists' base specialty of training on care process and outcomes of critically ill trauma patients.
        J Surg Res. 2013; 184: 577-581
      1. 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.