Analysis of the effect of conversion from open to closed surgical intensive care unit

Objective To compare the effect on clinical outcome of changing a surgical intensive care unit from an open to a closed unit. Design The study was carried out at a surgical intensive care unit in a lar ge tertiary care hospital, which was changed on January I, 1996, from an op en unit, where private attending physicians contributed and controlled the care of their patients, to a closed unit, where patients' medical care was provided only by the surgical critical care team (ABS or ABA board-certifie d intensivists). A retrospective review was undertaken over 6 consecutive m onths in each system, encompassing 274 patients (125 in the open-unit perio d, 149 in the closed-unit period). Morbidity and mortality were compared be tween the two periods, along with length-of-stay (LOS) and number of consul ts obtained. A set of independent variables was also evaluated, including a ge, gender, APACHE III scores, the presence of preexisting medical conditio ns, the use of invasive monitoring (Swan-Ganz catheters, central and arteri al lines), and the use of antibiotics, low-dose dopamine (LDD) for renal pr otection, vasopressors, TPN, and enteral feeding. Results Mortality (14.4% vs. 6.04%, p = 0.012) and the overall complication rate (55.84% vs. 44.14%, p = 0.002) were higher in the open-unit group ver sus the closed-unit group, respectively. The number of consults obtained wa s decreased (0.6 vs. 0.4 per patient, p = 0.036), and the rate of occurrenc e of renal failure was higher in the open-unit group (12.8% vs. 2.67%, p = 0.001). The mean age of the patients was similar in both groups 66.48 years vs. 66.40, p = 0.96). APACHE III scores were slightly higher in the open-u nit group but did not reach statistical significance (39.02 vs. 36.16, p = 0.222). There were more men in the first group (63.2% vs. 51.3%). The use o f Swan-Ganz catheters or central and arterial lines were identical, as was the use of antibiotics, TPN, and enteral feedings. The use of LDD was highe r in the first group, but the LOS was identical. Conclusions Conversion of a tertiary care surgical intensive care unit from an open to closed environment reduced dopamine usage and overall complicat ion and mortality rates. These results support the concept that, when possi ble, patients in surgical intensive care units should be managed by board-c ertified intensivists in a closed environment.