The association of closed-collaborative SICU modeling on emergency general surgery patient outcomes

•When compared to the open model, despite a sicker cohort of patients, a closed-collaborative SICU care model showed.•Higher mortality.•Similar clinical outcomes and rates of complications.•Reduction in hospital LOS. Surgical intensive care unit (SICU) optimization is a critical factor impacting pat...

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Veröffentlicht in:Surgery in practice and science Jg. 14; S. 100194
Hauptverfasser: Bennett, Joshua W., Schlortt, Kiley R., Yao, Tianyuan, Jensen, Hanna K., Reif, Rebecca J., Bennett, Judy L., Karim, Saleema A., Kimbrough, Mary K., Bhavaraju, Avi
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Elsevier Ltd 01.09.2023
Elsevier
Schlagworte:
Closed ICU
Collaborative ICU
EGS
SICU
Surgical ICU
Surgical ICU
EGS
Collaborative ICU
SICU
Closed ICU
ISSN:2666-2620, 2666-2620
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Zusammenfassung:•When compared to the open model, despite a sicker cohort of patients, a closed-collaborative SICU care model showed.•Higher mortality.•Similar clinical outcomes and rates of complications.•Reduction in hospital LOS. Surgical intensive care unit (SICU) optimization is a critical factor impacting patient outcomes and resource utilization. SICUs operate using an open or closed model, where the surgeon or intensivist, respectively, manages critically-ill patients. In 2017, we adopted a closed-collaborative model. This study aimed to compare patient outcomes in the closed-collaborative model vs. the previous open model in a cohort of emergency general surgery (EGS) patients. A retrospective review of EGS SICU patients from August 2015 to July 2019 was performed. Patients were divided into "Open" and "Closed" cohorts before or after closed-collaborative model implementation on August 1, 2017. Demographic variables and clinical outcomes were analyzed. We identified 434 patients (O:191; C:243). While no significant demographic differences were observed, there was a higher proportion of patients with qSOFA scores greater than 2 in the closed cohort. There were no differences regarding sepsis, cerebrovascular accident, myocardial infarction, venous thromboembolism, anemia, SICU length of stay (LOS), SICU costs, ventilation requirements, or ventilator duration; mortality rate was higher, but hospital LOS was shorter in the closed cohort. Overall, outcomes were not statistically different between the two models, despite sicker patients in the closed group, which we suspect accounts for the higher mortality in this group. We expect the decreased hospital LOS observed in the closed cohort improved bed management, patient flow, and ultimately led to institutional cost savings. Further investigation is warranted to examine SICU modeling effects in other surgical specialties and to evaluate potential hospital-level administrative benefits.
Bibliographie:ObjectType-Article-1
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content type line 23
ISSN:2666-2620
2666-2620
DOI:10.1016/j.sipas.2023.100194