title: The impact of organisational change on outcome in an intensive care unit in the United Kingdom.
abstract: OBJECTIVE
  To study the change in outcome for patients admitted to an intensive care unit following the establishment of a team of resident medical staff and a change from an "open" to a "closed" organisational format.
  
  
  METHODS
  Database review of prospectively collected data.
  
  
  METHODS
  Intensive care unit of a postgraduate teaching hospital.
  
  
  METHODS
  1134 admissions to the intensive care unit over a 3-year period, of whom 476 (42%) followed elective surgery.
  
  
  METHODS
  Hospital mortality corrected for illness severity by using the APACHE II scoring system.
  
  
  RESULTS
  Crude hospital mortality fell from 28% before the changes to 20% afterwards (P = 0.01). With correction for case-mix factors, the probability of death after the changes was reduced by almost half (OR 0.51; CI 0.32, 0.82, P = 0.005).
  
  
  CONCLUSIONS
  A "closed" format of organisation of the delivery of care may result in improved outcomes for patients admitted to intensive care units.
authors: Department of Anaesthesia and Intensive Care, Hammersmith Hospital, London, UK. g.baldock@ic.ac.uk
authors: G
authors: G
authors: Baldock
authors: P
authors: P
authors: Foley
authors: S
authors: S
authors: Brett
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006754:Hospital Restructuring; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008131:London / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D011184:Postoperative Period; D011446:Prospective Studies