Improving quality in surgical intensive care: The critical impact of intensivist presence and the semiopen unit model

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.