Improving Quality in Surgical Intensive Care: The Critical Impact of Intensivist Presence and the Semiopen Unit Model

IF 2.4 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice Pub Date : 2025-05-21 DOI:10.1155/ijcp/8731737

Serdar Efe, Şenay Yiğit Avcı, Ekrem Kaya, Emel Yılmaz

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引用次数: 0

Abstract

Background: It is well known that intensivist in the intensive care unit (ICU) is critical for optimal patient care. However, today the majority of surgical intensive care units (SICUs) provide service in an open model. Our aim was to assess the effects of appointing an intensivist to the SICU and transitioning to a semi-open working model on patient outcomes and various quality indicators.

Methods: This retrospective study was conducted in a seven-bed SICU of a university hospital. Two groups were created from patients treated before (preintensivist period) and after (postintensivist period) the change of ICU management. Demographic data of the patients, disease severity scores, surgical interventions performed, and intensive care quality indicators were collected and statistically compared between the two periods. Reporting of this study complied with the “Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0)” standards.

Results: With the introduction of an intensive care specialist during working hours and the adoption of a semiopen working model, the following improvements were observed: the average length of stay decreased from 11 days versus 5 days, the average duration of mechanical ventilation reduced from 5.6 days versus 1 day, and the rate of mechanical ventilation use decreased from 48% versus 21%. A significant reduction in the need for tracheostomy was also noted (p < 0.001). Furthermore, the bed turnover rate increased from 20 versus 24, enhancing bed utilization efficiency. Additionally, the observed mortality rate of 15% was lower than the expected rate of 25%, resulting in a significant reduction in the standardized mortality ratio (from 1.05 vs. 0.6).

Conclusion: This study proves that surgeon-intensivist collaboration and a semiopen model in ICUs play a critical role by reducing mortality, increasing resource utilization efficiency, and improving patient outcomes. Our findings emphasize the need to restructure SICU processes with a multidisciplinary approach.

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提高外科重症监护质量：重症医师存在和半开放式病房模式的关键影响

背景：众所周知，重症监护病房（ICU）的重症医师对患者的最佳护理至关重要。然而，今天大多数外科重症监护病房（sicu）以开放模式提供服务。我们的目的是评估任命一名重症医师到SICU并过渡到半开放式工作模式对患者预后和各种质量指标的影响。方法：本回顾性研究在一所大学医院的七床SICU进行。两组患者分别在ICU管理改变前（重症监护前）和后（重症监护后）接受治疗。收集两期患者的人口统计数据、疾病严重程度评分、手术干预和重症监护质量指标，并进行统计比较。本研究的报告符合“修订质量改进报告卓越标准（SQUIRE 2.0）”标准。结果：在工作时间引入重症监护专家并采用半开放式工作模式后，观察到以下改善：平均住院时间从11天减少到5天，平均机械通气时间从5.6天减少到1天，机械通气使用率从48%减少到21%。气管切开术的需求也显著减少(p <；0.001)。床位周转率由20次提高到24次，提高了床位利用效率。此外，15%的观察死亡率低于25%的预期死亡率，导致标准化死亡率显著降低（从1.05 vs. 0.6）。结论：本研究证明了icu中外科-强化合作和半开放模式在降低死亡率、提高资源利用效率和改善患者预后方面发挥着至关重要的作用。我们的研究结果强调了用多学科方法重组SICU过程的必要性。

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来源期刊

International Journal of Clinical Practice 医学-医学：内科

CiteScore

5.30

自引率

0.00%

发文量

274

审稿时长

3-8 weeks

期刊介绍： IJCP is a general medical journal. IJCP gives special priority to work that has international appeal. IJCP publishes: Editorials. IJCP Editorials are commissioned. [Peer reviewed at the editor''s discretion] Perspectives. Most IJCP Perspectives are commissioned. Example. [Peer reviewed at the editor''s discretion] Study design and interpretation. Example. [Always peer reviewed] Original data from clinical investigations. In particular: Primary research papers from RCTs, observational studies, epidemiological studies; pre-specified sub-analyses; pooled analyses. [Always peer reviewed] Meta-analyses. [Always peer reviewed] Systematic reviews. From October 2009, special priority will be given to systematic reviews. [Always peer reviewed] Non-systematic/narrative reviews. From October 2009, reviews that are not systematic will be considered only if they include a discrete Methods section that must explicitly describe the authors'' approach. Special priority will, however, be given to systematic reviews. [Always peer reviewed] ''How to…'' papers. Example. [Always peer reviewed] Consensus statements. [Always peer reviewed] Short reports. [Always peer reviewed] Letters. [Peer reviewed at the editor''s discretion] International scope IJCP publishes work from investigators globally. Around 30% of IJCP articles list an author from the UK. Around 30% of IJCP articles list an author from the USA or Canada. Around 45% of IJCP articles list an author from a European country that is not the UK. Around 15% of articles published in IJCP list an author from a country in the Asia-Pacific region.