The impact of organisational change on outcome in an intensive care unit in the United Kingdom.

Abstract

To study the change in outcome for patients admitted to an intensive care unit following the establishment of a team of resident medical staff and a change from an "open" to a "closed" organisational format. Database review of prospectively collected data. Intensive care unit of a postgraduate teaching hospital. 1134 admissions to the intensive care unit over a 3-year period, of whom 476 (42%) followed elective surgery. Hospital mortality corrected for illness severity by using the APACHE II scoring system. Crude hospital mortality fell from 28% before the changes to 20% afterwards (P = 0.01). With correction for case-mix factors, the probability of death after the changes was reduced by almost half (OR 0.51; CI 0.32, 0.82, P = 0.005). A "closed" format of organisation of the delivery of care may result in improved outcomes for patients admitted to intensive care units.