title: Changes in intensive care unit performance measures associated with opening a dedicated thoracic surgical progressive care unit.
abstract: OBJECTIVE
  To determine the effect of the introduction of a specialty-specific progressive care unit (PCU) on the intensive care unit (ICU) to which relatively low-acuity patients had previously been admitted.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  The thoracic (noncardiac) surgical ICU of a tertiary referral institution.
  
  
  METHODS
  Four thousand fifty-three patients admitted to the ICU after thoracic surgery between October 1994 and December 2003.
  
  
  METHODS
  None.
  
  
  RESULTS
  The institutional Acute Physiology and Chronic Health Evaluation (APACHE) III database was searched to compare the number of admissions, severity of illness, mortality, and other aspects of care for periods before and after the introduction of the PCU. Patients in the post-PCU group were more severely ill by APACHE criteria. The ICU mortality rates for the periods before and after the introduction of the PCU were 1.14% (32/2,801 patients) and 7.27% (91/1,252 patients), respectively. The performance of the ICU appeared to be worse in the period after the opening of the PCU. The ICU- and hospital-customized standardized mortality ratio increased from 0.68 (95% confidence interval [CI], 0.47-0.96) in the pre-PCU group to 1.20 (95% CI, 0.96-1.47) in the post-PCU group and from 0.83 (95% CI, 0.66-1.03) to 1.24 (95% CI, 1.05-1.46).
  
  
  CONCLUSIONS
  The introduction of a nonintensivist-directed PCU to care for thoracic surgical patients had a significant impact on the parent ICU. Of concern is that outcome and quality measures appeared to worsen and ICU readmission rate increased.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA. keegan.mark@mayo.edu
authors.forename: Mark T
authors.initials: MT
authors.lastname: Keegan
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Brown
authors.forename: Michael P
authors.initials: MP
authors.lastname: Thieke
authors.forename: Bekele
authors.initials: B
authors.lastname: Afessa
mesh_terms: D018806:APACHE; D000368:Aged; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000639:trends; D008297:Male; D008875:Middle Aged; D012107:Research Design / Q000592:standards* / Q000639:trends; D012189:Retrospective Studies; D013903:Thoracic Surgery / Q000592:standards* / Q000639:trends