Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2021 Feb 2;10(3):e018182.
doi: 10.1161/JAHA.120.018182. Epub 2021 Jan 8.

Transition From an Open to Closed Staffing Model in the Cardiac Intensive Care Unit Improves Clinical Outcomes

P Elliott Miller  1   2 , Fouad Chouairi  1 , Alexander Thomas  3 , Yukiko Kunitomo  3 , Faisal Aslam  3 , Maureen E Canavan  4 , Christa Murphy  5 , Krishna Daggula  6 , Thomas Metkus  7 , Saraschandra Vallabhajosyula  8 , Anthony Carnicelli  9 , Jason N Katz  9 , Nihar R Desai  1   10 , Tariq Ahmad  1   10 , Eric J Velazquez  1 , Joseph Brennan  1
Affiliations
Comparative Study

Transition From an Open to Closed Staffing Model in the Cardiac Intensive Care Unit Improves Clinical Outcomes

P Elliott Miller et al. J Am Heart Assoc. .

Abstract

Background Several studies have shown improved outcomes in closed compared with open medical and surgical intensive care units. However, very little is known about the ideal organizational structure in the modern cardiac intensive care unit (CICU). Methods and Results We retrospectively reviewed consecutive unique admissions (n=3996) to our tertiary care CICU from September 2013 to October 2017. The aim of our study was to assess for differences in clinical outcomes between an open compared with a closed CICU. We used multivariable logistic regression adjusting for demographics, comorbidities, and severity of illness. The primary outcome was in-hospital mortality. We identified 2226 patients in the open unit and 1770 in the closed CICU. The unadjusted in-hospital mortality in the open compared with closed unit was 9.6% and 8.9%, respectively (P=0.42). After multivariable adjustment, admission to the closed unit was associated with a lower in-hospital mortality (odds ratio [OR], 0.69; 95% CI: 0.53-0.90, P=0.007) and CICU mortality (OR, 0.70; 95% CI, 0.52-0.94, P=0.02). In subgroup analysis, admissions for cardiac arrest (OR, 0.42; 95% CI, 0.20-0.88, P=0.02) and respiratory insufficiency (OR, 0.43; 95% CI, 0.22-0.82, P=0.01) were also associated with a lower in-hospital mortality in the closed unit. We did not find a difference in CICU length of stay or total hospital charges (P>0.05). Conclusions We found an association between lower in-hospital and CICU mortality after the transition to a closed CICU. These results may help guide the ongoing redesign in other tertiary care CICUs.

Keywords: acute cardiovascular care; healthcare delivery; intensive care.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1
Figure 1. Organizational staffing change in the cardiac intensive care unit*.
*Example staffing. CICU indicates cardiac intensive care unit.
Figure 2
Figure 2. Forest plot of odds ratios for mortality outcomes.
CICU indicates cardiac intensive care unit.
Figure 3
Figure 3. Forest plot of odds ratios for subgroup in‐hospital mortality stratified by CICU indication.
CICU indicates cardiac intensive care unit; and HF, heart failure.
See this image and copyright information in PMC

References

    1. Julian DG. Treatment of cardiac arrest in acute myocardial ischaemia and infarction. Lancet. 1961;2:840–844. - PubMed
    1. Bohula EA, Katz JN, van Diepen S, Alviar CL, Baird‐Zars VM, Park JG, Barnett CF, Bhattal G, Barsness GW, Burke JA, et al. Demographics, care patterns, and outcomes of patients admitted to cardiac intensive care units. The Critical Care Cardiology Trials Network Prospective North American Multicenter Registry of Cardiac Critical Illness. JAMA Cardiol. 2019;4:928–935. - PMC - PubMed
    1. Holland EM, Moss TJ. Acute noncardiovascular illness in the cardiac intensive care unit. J Am Coll Cardiol. 2017;69:1999–2007. - PubMed
    1. Fuster V. The (R)Evolution of the CICU: better for the patient, better for education. J Am Coll Cardiol. 2018;72:2269–2271. - PubMed
    1. Katz JN, Minder M, Olenchock B, Price S, Goldfarb M, Washam JB, Barnett CF, Newby LK, van Diepen S. The genesis, maturation, and future of critical care cardiology. J Am Coll Cardiol. 2016;68:67–79. - PubMed

Publication types

LinkOut - more resources