Survival experience of chronically critically ill patients.
Intensive care unit (ICU) patients were randomly assigned to either a traditional ICU or a special care unit (SCU) for chronically critically ill patients. The SCU used a low-technology, family-oriented environment, nursing case management, no physician house staff, and a shared governance model. In comparison, the ICU used high technology, limited family visiting, primary care nursing, and a bureaucratic management model. The survival experience of chronically critically ill patients in the two environments during hospitalization, as well as after hospital discharge, was examined. Using survival analytic techniques, the 1-year cumulative mortality for all patients in the study was found to be 59.9%. Risk of death was significantly lower after discharge than during hospitalization. Similar mortality experiences were found for SCU and ICU patients. Thus, the high-technology ICU environment did not produce better outcomes than the SCU environment.
Douglas
S
S
Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH, USA.
Daly
B J
BJ
Rudy
E B
EB
Sereika
S M
SM
Menzel
L
L
Song
R
R
Dyer
M A
MA
Montenegro
H D
HD
D000368:Aged; D019090:Case Management; D002908:Chronic Disease / Q000401:mortality* / Q000451:nursing*; D003422:Critical Care / Q000458:organization & administration*; D016638:Critical Illness / Q000401:mortality* / Q000451:nursing*; D003659:Decision Making, Organizational; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013677:Medical Laboratory Science; D008875:Middle Aged; D018802:Patient-Centered Care; D016019:Survival Analysis; D016896:Treatment Outcome