title: Impact of a new model of intensive care medicine upon healthcare in a department of intensive care medicine.
abstract: OBJECTIVE
  To evaluate a new organizational model in an intensive care unit, with the implementation of early warning systems and a support unit.
  
  
  METHODS
  A retrospective, comparative cohort study was carried out.
  
  
  METHODS
  The study was carried out in the Department of Intensive Care Medicine (DICM) of a tertiary hospital (2009-2011), with the comparison of three time periods (P1, P2 and P3) that differed in terms of organization and logistics.
  
  
  METHODS
  We analyzed all patients admitted to the ICU during the study period. Patients from maternal and infant intensive care were excluded.
  
  
  METHODS
  Percentage of patients with stays of under two days, with invasiveness used; readmission to the DICM, type of admission and percentage of stays of longer than one month; APACHE II score, mean stay in the ICU and shift distribution of the admissions.
  
  
  RESULTS
  We analyzed a sample of 3209 patients (65% males), with a mean age of 58.23 (18.23) years, a mean APACHE II score of 16.67 (8.23), and presenting an occupancy rate of 7.3 (10.3) days in the analyzed period. The ratio APACHE II score/number of beds was 0.69 (0.34) in P1, compared to 0.68 (0.33) in P2 and 0.76 (0.37) in P3 (p<0.001). The intervention surveillance grade (grade 1) was 42% (39-46%) in P1, 40% (37-43%) in P2 and 31% (28-35%) in P3 (p<0.001). The average stay in the ICU ranged from 7.10 days (8.82) in P1 to 6.60 days (9.49) in P2 and 8.42 days (12.73) in P3 (p<0.001).
  
  
  CONCLUSIONS
  There has been an increase in the number of patients seen in our DICM, with a decrease in the patients admitted to the conventional ICU. Patients now admitted to the ICU are more seriously ill, require a greater level of intervention, and give rise to an increase in the mean duration of stay in the ICU.
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España. jandro120475@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: González-Castro
authors.forename: F
authors.initials: F
authors.lastname: Ortiz-Melon
authors.forename: B
authors.initials: B
authors.lastname: Suberviola
authors.forename: M S
authors.initials: MS
authors.lastname: Holanda
authors.forename: M J
authors.initials: MJ
authors.lastname: Dominguez
authors.forename: C
authors.initials: C
authors.lastname: Blanco-Huelga
authors.forename: C
authors.initials: C
authors.lastname: Muñoz
mesh_terms: D015331:Cohort Studies; D003422:Critical Care / Q000592:standards*; D005260:Female; D006748:Hospital Departments / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D012189:Retrospective Studies