Feasibility and Early Outcomes of Intensivist-Led Critical Care after Major Trauma in the Korean ICU

Kim, Kil Dong; Lee, Jun Wan; Park, Hyeung Keun

doi:10.3349/ymj.2013.54.2.432

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…Similar to this analysis, other studies showed in-hospital mortality rates for trauma, [17] surgical [13] and cancer patients [18] admitted to a closed format ICU were significantly lower. Decreased surgical morbidity was also observed in a closed format where better care could be provided by the intensivist and team.…”

Section: Discussionsupporting

confidence: 86%

Mortality rate and other clinical features observed in Open vs closed format intensive care units

Yang

Feng

2019

Medicine

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Background: Nowadays most of the intensive care units (ICUs) operate as a closed format in comparison to an open format. The new concept of a closed ICU is where patients are admitted under the full responsibility of a trained intensivist, whereas an open ICU is where patients are admitted under the care of another attending physician and intensivists are just available for consultation. In this analysis, we aimed to systematically compare mortality rate and other clinical features observed in open vs closed ICU formats. Methods: Biomedical and pharmacological bibliographic database Excerpta Medica database (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), the Cochrane Central and www.ClinicalTrials.gov were searched for required English publications. Mortality, the frequency of patients requiring mechanical ventilation, central line, arterial line and pulmonary arterial catheter were assessed respectively. Statistical analysis was carried out by the RevMan software. Odds ratios (OR) with 95% confidence intervals (CIs) were used to represent the data following analysis. Results: Five studies with a total number of 6160 participants enrolled between years 1992 to 2007 were included. Results of this analysis showed that mortality rate was significantly higher in the open format ICU (OR: 1.31, 95% CI: 1.17–1.48; P = .00001) (using a fixed effect model) and (OR: 1.31, 95% CI: 1.09–1.59; P = .005) (using a random effect model). Closed format ICUs were associated with significantly higher number of patients that required central line (OR: 0.56, 95% CI: 0.34–0.92; P = .02). Patients requiring mechanical ventilation (OR: 1.08, 95% CI: 0.65–1.78; P = .77), patients requiring arterial line (OR: 1.05, 95% CI: 0.49–2.29; P = .89) and patients requiring pulmonary arterial catheter (OR: 0.86, 95% CI: 0.40–1.87; P = .71) were similar in the open vs the closed setting. Conclusion: This analysis showed that mortality rate was significantly higher in an open as compared to a closed format ICU. However, the frequency of patients requiring mechanical ventilation, arterial line and pulmonary arterial catheter was similarly observed. Larger trials are expected to further confirm those hypotheses.

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Section: Discussionsupporting

confidence: 86%

Mortality rate and other clinical features observed in Open vs closed format intensive care units

Yang

Feng

2019

Medicine

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Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey

Lee

Moon

Youn

et al. 2016

Korean J Crit Care Med

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Background: Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea. Methods: An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS). Results: Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues. Conclusions: Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist's role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.

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Feasibility and Early Outcomes of Intensivist-Led Critical Care after Major Trauma in the Korean ICU

Cited by 2 publications

References 15 publications

Mortality rate and other clinical features observed in Open vs closed format intensive care units

Mortality rate and other clinical features observed in Open vs closed format intensive care units

Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey

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