A CLOSED MEDICAL INTENSIVE-CARE UNIT (MICU) IMPROVES RESOURCE UTILIZATION WHEN COMPARED WITH AN OPEN MICU

We hypothesized that a ''closed'' intensive care unit (ICU) was more e fficient that an ''open'' one. ICU admissions were retrospectively ana lyzed before and after ICU closure at one hospital; prospective analys is in that ICU with an open ICU nearby was done. Illness severity was gauged by the Mortality Prediction Model (MPM0). Outcomes included mor tality, ICU length of stay (LOS), hospital LOS, and mechanical ventila tion (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; h ospital 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 LO S; ICU organization and MPM0 predicted days on MV; MV and ICU organiza tion 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 m ore efficient with a closed ICU, and that mortality is not adversely a ffected.