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Vol.73 No.2
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The Impact of Implementing Critical Care Team on Open General Intensive Care Unit

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2012, v.73 no.2, pp.100-106



Seonguk Kim (Konkuk University School of Medicine)
(Chungju)
Seung Seok Ki (Konkuk University School of Medicine)
Seonguk, K. , & Seung, S. K. (2012). The Impact of Implementing Critical Care Team on Open General Intensive Care Unit. Tuberculosis & Respiratory Diseases, 73(2), 100-106.
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Abstract

Background: There are a plethora of literatures showing that high-intensity intensive care unit (ICU) physician staffing is associated with reduced ICU mortality. However, it is not widely used in ICUs because of limited budgets and resources. We created a critical care team (CCT) to improve outcomes in an open general ICU and evaluated its effectiveness based on patients' outcomes. Methods: We conducted this prospective, observational study in an open, general ICU setting, during a period ranging from March of 2009 to February of 2010. The CCT consisted of five teaching staffs. It provided rapid medical services within three hours after calls or consultation. Results: We analyzed the data of 830 patients (157 patients of the CCT group and 673 patients of the non-CCT one). Patients of the CCT group presented more serious conditions than those of the non-CCT group (acute physiologic and chronic health evaluation II [APACHE II] 20.2 vs. 15.8, p＜0.001; sequential organ failure assessment [SOFA] 5.5 vs. 4.6, p=0.003). The CCT group also had significantly more patients on mechanical ventilation than those in the non-CCT group (45.9% vs. 23.9%, p＜0.001). Success rate of weaning was significantly higher in the CCT group than that of the non-CCT group (61.1% vs. 44.7%, p=0.021). On a multivariate logistic regression analysis, the increased ICU mortality was associated with the older age, non-CCT, higher APACHE II score, higher SOFA score and mechanical ventilation (p＜0.05). Conclusion: Although the CCT did not provide full-time services in an open general ICU setting, it might be associated with a reduced ICU mortality. This is particularly the case with patients on mechanical ventilation.

keywords
Critical Care, Intensive Care Units, Mortality

Reference

1.

1. Brown JJ, Sullivan G. Effect on ICU mortality of a full-time critical care specialist. Chest 1989;96:127-9.

2.

2. Baldock G, Foley P, Brett S. The impact of organisational change on outcome in an intensive care unit in the United Kingdom. Intensive Care Med 2001;27: 865-72.

3.

3. Kuo HS, Tang GJ, Chuang JH, Lee CH, Lui WY, Lee TY, et al. Changing ICU mortality in a decade: effect of full-time intensivist. Crit Care Shock 2000;3:57-61.

4.

4. Ghorra S, Reinert SE, Cioffi W, Buczko G, Simms HH. Analysis of the effect of conversion from open to closed surgical intensive care unit. Ann Surg 1999; 229:163-71.

5.

5. Manthous CA, Amoateng-Adjepong Y, al-Kharrat T, Jacob B, Alnuaimat HM, Chatila W, et al. Effects of a medical intensivist on patient care in a community teaching hospital. Mayo Clin Proc 1997;72:391-9.

6.

6. Rosenfeld BA, Dorman T, Breslow MJ, Pronovost P, Jenckes M, Zhang N, et al. Intensive care unit telemedicine: alternate paradigm for providing continuous intensivist care. Crit Care Med 2000;28:3925-31.

7.

7. Goh AY, Lum LC, Abdel-Latif ME. Impact of 24 hour critical care physician staffing on case-mix adjusted mortality in paediatric intensive care. Lancet 2001;357: 445-6.

8.

8. Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 2002;288:2151-62.

9.

9. Varelas PN, Conti MM, Spanaki MV, Potts E, Bradford D, Sunstrom C, et al. The impact of a neurointensivist- led team on a semiclosed neurosciences intensive care unit. Crit Care Med 2004;32:2191-8.

10.

10. Hawari FI, Al Najjar TI, Zaru L, Al Fayoumee W, Salah SH, Mukhaimar MZ. The effect of implementing high-intensity intensive care unit staffing model on outcome of critically ill oncology patients. Crit Care Med 2009;37:1967-71.

11.

11. Fuchs RJ, Berenholtz SM, Dorman T. Do intensivists in ICU improve outcome? Best Pract Res Clin Anaesthesiol 2005;19:125-35.

12.

12. Young MP, Birkmeyer JD. Potential reduction in mortality rates using an intensivist model to manage intensive care units. Eff Clin Pract 2000;3:284-9.

13.

13. Levy MM, Rapoport J, Lemeshow S, Chalfin DB, Phillips G, Danis M. Association between critical care physician management and patient mortality in the intensive care unit. Ann Intern Med 2008;148:801-9.

14.

14. Korean Society of Critical Care Medicine. The Korean Society of Critical Care Medicine white paper: domestic intensive care units survey report 2009. Seoul: Korean Society of Critical Care Medicine; 2010. p. 27-45.

15.

15. Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 2005;365:2091-7.

16.

16. Guidelines for intensive care unit admission, discharge, and triage. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med 1999;27:633-8.

17.

17. Rochester DF. Tests of respiratory muscle function. Clin Chest Med 1988;9:249-61.

18.

18. Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA 2006;295:324-7.

19.

19. Devita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med 2006;34:2463-78.

20.

20. Multz AS, Chalfin DB, Samson IM, Dantzker DR, Fein AM, Steinberg HN, 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(5 Pt 1):1468-73.

21.

21. Carson SS, Stocking C, Podsadecki T, Christenson J, Pohlman A, MacRae S, 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;276:322-8.

22.

22. Wong DT, Crofts SL, Gomez M, McGuire GP, Byrick RJ. Evaluation of predictive ability of APACHE II system and hospital outcome in Canadian intensive care unit patients. Crit Care Med 1995;23:1177-83.

23.

23. Naved SA, Siddiqui S, Khan FH. APACHE-II score correlation with mortality and length of stay in an intensive care unit. J Coll Physicians Surg Pak 2011;21: 4-8.

24.

24. Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286:1754-8.

25.

25. Minne L, Abu-Hanna A, de Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU: a systematic review. Crit Care 2008;12:R161.

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