J. D. Young1, K. Sexton1, A. Bhavaraju1, M. K. Kimbrough1, B. Davis1, D. Crabtree1, N. Saied1, J. Taylor1, W. Beck1 1University of Arkansas for Medical Sciences,Division Of Acute Care Surgery/Department Of Surgery,Little Rock, AR, USA
Introduction: Various physician staffing models exist for providing care to trauma patients requiring intensive (ICU) care. Our institution went from an open ICU to a closed ICU in August 2017. The closed ICU mandated the primary responsibility for the care of trauma patients to be directed by board certified/eligible surgical intensivists. We hypothesized that this would decrease respiratory failure requiring tracheostomy in trauma patients.
Methods: After IRB approval, a retrospective review of all patients in our trauma registry with ventilator days > 1 were included for this study (2,206 total patients). We then examined all National Trauma Data Set (NTDS) variables and procedures to include tracheostomy.
Results: There was no difference observed in gender, race, or mortality rates. The open ICU was noted to have had a higher percentage of penetrating trauma (21.4% vs 13.4%, P = .0019). The following data were observed.
Conclusion: A closed, surgical intensivist run ICU resulted in a statistically significant difference not only in tracheostomy rates, but also ICU length of stay, hospital length of stay, and ventilator days. These changes were also achieved while seeing a significantly sicker patient population as evidenced by a higher Injury Severity Score (ISS).
