P005: CLOSED VS OPEN SICU MODELS AND THEIR TRAUMA PATIENT OUTCOMES: A LEVEL II TRAUMA CENTER & COMMUNITY HOSPITAL PERSPECTIVE
Prabhleen Kaur1; Amber Hendricks2; Nicholas Druar2; Roxanne Tapley2; Carina Biggs2
1HCA Florida Oakhill Hospital; 2Saint Mary's Hospital, Waterbury, Connecticut
Introduction: The optimization of intensive care unit (ICU) care impacts clinical outcomes and resource utilization. In 2021, 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 the cohort of trauma patients admitted to our adult level II trauma center, community hospital.
Methods: Our SICU was converted into the “closed" collaborative model on May 1, 2021. A retrospective review of the Institutional Trauma registry was performed for the adult trauma admissions to SICU between April 1, 2018 to May 31, 2024. The cohort of patients in the washout period six months before and after May 1, 2021, was excluded. The primary outcomes were comparing the Mortality rate and SICU Length of stay. Patients were divided into those admitted between April 1, 2018 to October 31, 2020 (the "open" cohort) and those admitted between Nov 1, 2021 to May 31, 2024 (the “closed” cohort). Demographic variables and clinical outcomes were analyzed. Trauma severity was assessed using the injury severity score (ISS). Statistical analysis was completed using Strata. A univariable analysis was conducted, followed by a multivariable analysis to control for age and ISS. A p-value of 0.05 or less was considered significant.
Results (Table 1): A total of 747 patients were analyzed (Open: 319 (42.7%); Closed: 428 (57.3%). No significant differences in demographics were observed. On Univariate analysis, the mean LOS was higher in the closed model (O: 2.9 days, C: 3.7 days, p-value 0.006). The mortality rate of patients in the open ICU was 11% (36 patients out of 319) compared to 6% in the closed ICU (29 patients out of 428), with an odds ratio of 0.57 (95% CI of 0.33-0.98).
Conclusions: Despite a nearly 50% decrease in the mortality rate, this result was not statistically significant due to the small sample size and comparatively recent conversion to a closed model. After further retrospective review, the mean increase in LOS in the closed collaborative model was due to no vacancy in hospital beds to transfer out, despite patients deemed to be medically stable for transfer. A dedicated critical care service in trauma leads to better outcomes, both in patient care and hospital resource utilisation, even at a community hospital, level II center. Further research is planned to include a higher sample size and additional parameters to assess the healthcare quality outcomes of a closed SICU model.