title: Intensive care unit design and mortality in trauma patients.
abstract: BACKGROUND
  The architecture of medical care facilities ca affect the safety of a patient, but it is unknown if the architecture affects outcomes. We hypothesized that patients in rooms who are more visible from the central nursing station would experience better outcomes than those patients in less visible rooms.
  
  
  METHODS
  A total of 773 patients admitted to the trauma intensive care service over a 12-mo period were retrospectively evaluated. Outcomes were hospital mortality and intensive care unit (ICU) length of stay (LOS). The unit is designed with a bank of high-visibility rooms (HVRs) directly across from the nursing station and two side sections of low-visibility rooms (LVRs). No formal triage occurs, but patients are prioritized to HVRs as available.
  
  
  RESULTS
  Patients in the HVRs had a 16% mortality (52 of 320); meanwhile, the patients in the LVRs experienced an 11% mortality (49 of 448, P = 0.03). ICU mortality did not differ significantly when controlling for age, Charlson Comorbidity Index (CCI), Head Abbreviated Injury Score, and the Injury Severity Score (ISS) (P = 0.076). Age, CCI, Head Abbreviated Injury Score, and ISS did individually correlate with mortality (age: P = 0.0008; CCI: P = 0.017; and ISS: P < 0.0001). Visibility was not a predictor of ICU LOS or complications among survivors (mean ICU HVR LOS = 4.8 d; mean ICU LVR LOS = 4.7; P = 0.88, n = 661). Only ISS was a significant predictor of ICU LOS and complications (P < 0.0001).
  
  
  CONCLUSIONS
  Trauma patient room placement within the ICU does not relate to mortality rate significantly when corrected for patient acuity. Instead, variables such as age, ISS, and CCI are associated with mortality. A policy of placing more critically ill patients in HVRs may prevent increased mortality in high-acuity patients.
authors.affiliation: Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Pettit
authors.affiliation: Trauma and Acute Care Surgery, Grant Medical Center-Ohio Health, Columbus, Ohio.
authors.forename: Teresa
authors.initials: T
authors.lastname: Wood
authors.affiliation: Trauma and Acute Care Surgery, Grant Medical Center-Ohio Health, Columbus, Ohio.
authors.forename: Mike
authors.initials: M
authors.lastname: Lieber
authors.affiliation: Trauma and Acute Care Surgery, Grant Medical Center-Ohio Health, Columbus, Ohio. Electronic address: shay.omara@ohiohealth.com.
authors.forename: Michael S
authors.initials: MS
authors.lastname: O'Mara
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D063187:Nursing Stations; D009820:Ohio / Q000453:epidemiology; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality*
keywords: ICU; ICU design; Intensive care unit; Mortality; Trauma