title: The impact of open versus closed format ICU admission practices on the outcome of high risk surgical patients: a cohort analysis.
abstract: BACKGROUND
  In the year 2000, the organizational structure of the ICU in the Zaandam Medical Centre (ZMC) changed from an open to a closed format ICU. The objective of this study was to evaluate the effect of this organizational change on outcome in high risk surgical patients.
  
  
  METHODS
  The medical records of all consecutive high risk surgical patients admitted to the ICU from 1996 to 1998 (open format) and from 2003 to 2005 (closed format), were reviewed. High-risk patients were defined according to the Identification of Risk in Surgical patients (IRIS) score. Parameters studied were: mortality, morbidity, ICU length of stay (LOS) and hospital LOS.
  
  
  RESULTS
  Mortality of ICU patients was 25.7% in the open format group and 15.8% in the closed format group (p = 0.01). Morbidity decreased from 48.6% to 46.1% (p = 0.6). The average length of hospital stay was 17 days in the open format group, and 21 days in the closed format group (p = 0.03).
  
  
  CONCLUSIONS
  High risk surgical patients in the ICU are patients that have undergone complex and often extensive surgery. These patients are in need of specialized treatment and careful monitoring for maximum safety and optimal care. Our results suggest that closed format is a more favourable setting than open format to minimize the effects of high risk surgery, and to warrant safe outcome in this patient group.
authors.affiliation: Department of Surgery of the Zaandam Medical Centre, Zaandam, The Netherlands.
authors.forename: Frederik J
authors.initials: FJ
authors.lastname: van der Sluis
authors.forename: Cornelis
authors.initials: C
authors.lastname: Slagt
authors.forename: Barbara
authors.initials: B
authors.lastname: Liebman
authors.forename: Jan
authors.initials: J
authors.lastname: Beute
authors.forename: Jan W R
authors.initials: JW
authors.lastname: Mulder
authors.forename: Alexander F
authors.initials: AF
authors.lastname: Engel
mesh_terms: D018806:APACHE; D000368:Aged; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D009426:Netherlands; D009936:Organizational Innovation; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010343:Patient Admission / Q000639:trends*; D011446:Prospective Studies; D011787:Quality of Health Care; D012307:Risk Factors