The impact of organisational change on outcome in an intensive care unit in the United Kingdom.
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.
Baldock
G
G
Department of Anaesthesia and Intensive Care, Hammersmith Hospital, London, UK. g.baldock@ic.ac.uk
Foley
P
P
Brett
S
S
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