An open intensive care unit (ICU) model is a viable option for the acute expansion of ICU capacity in the state sector: A study of a needs-based strategy during the COVID-19 pandemic in a tertiary ICU in South Africa

Abstract

Background: Both open and closed intensive care unit (ICU) models are used in South Africa (SA). The literature is unclear with regard to which model is superior. The COVID-19 pandemic led to a critical care resource crisis that necessitated expansion of critical care capacity, often beyond the resources required to meet the structure of a closed ICU in the institutions using that model.

Objectives: This retrospective study aimed to compare the outcomes of non-COVID patients in a closed ICU setting and a temporary open unit that ran parallel to it during the pandemic, in order to assess this type of resource expansion as a viable option.

Methods: Data from the Intensive Care Electronic Record System in the Greys Hospital ICU in Pietermaritzburg, SA, were analysed for patients aged ≥12 years admitted to either the open or the closed ICU between April and August 2020. Data missing from the database were completed by referring to the medical records office. The primary outcome assessed was mortality, while secondary outcomes included adverse events and hospital length of stay.

Results: There was no significant mortality difference between the ICU components (16.9% in the open-model group v. 15.1% in the closed model group; p=0.769). The incidence of adverse events also did not differ (45.5% in the open model v. 38.9% in the closed model; p=0.357).

Conclusion: Patients requiring ICU admission have complex conditions or have undergone extensive surgery, necessitating specialised treatment and careful monitoring. In the event of an acute surge event, expanding ICU capacity by adding an open-model component in a setting that traditionally runs closed models may be an effective strategy to assist in the management of critically ill patients without significantly affecting outcomes.

Study synopsis: What the study adds. This retrospective study compared outcomes of non-COVID patients in a closed intensive care unit (ICU) v. a temporary open unit during the pandemic. The efficacy of open v. closed ICU models remains uncertain in the South African context. The study offers insights into the effectiveness of open and closed ICU models, particularly in the context of crises during which institutions may face a critical care resource shortage.Implications of the findings. The study suggests that incorporating open ICU units during crises can manage patient surges effectively without compromising outcomes. It contributes to the existing literature by providing practical implications for resource management, clinical practice and future research, ensuring quality patient care while optimising critical care capacity.

Keywords: COVID-19; ICU; South Africa; resource expansion.

Fig. 1

Risk factors for mortality in the total sample – Forrest plot indicating significant associations between independent variables and mortality. Relationships are expressed as odds ratios with 95% confidence intervals.

Fig. 2

Risk factors for mortality in the open ICU – Forrest plot indicating significant associations between independent variables and mortality in the open ICU model. Relationships are expressed as odds ratios with 95% confidence intervals. ICU = intensive care unit