Abstract：
BACKGROUND: The optimization of intensive care unit (ICU) care impacts clinical outcomes and resource utilization. In 2017, our surgical ICU (SICU) adopted a \"closed-collaborative\" model. The aim of this study is to compare patient outcomes in the closed-collaborative model versus the previous open model in a cohort of trauma surgical patients admitted to our adult level 1 trauma center.
METHODS: A retrospective review of trauma patients in the SICU from August 1, 2015 to July 31, 2019 was performed. Patients were divided into those admitted prior to August 1, 2017 (the \"open\" cohort) and those admitted after August 1, 2017 (the \"closed-collaborative\" cohort). Demographic variables and clinical outcomes were analyzed. Trauma severity was assessed using injury severity score (ISS).
RESULTS: We identified 1669 patients (O: 895; C: 774). While no differences in demographics were observed, the closed-collaborative cohort had a higher overall ISS (O: 21.5 ± 12.14; C: 25.10 ± 2.72; P < 0.0001). There were no significant differences between the two cohorts in the incidence of strokes (O: 1.90%; C: 2.58%, P = 0.3435), pulmonary embolism (O: 0.78%; C: 0.65%; P = 0.7427), sepsis (O: 5.25%; C: 7.49%; P = 0.0599), median ICU charges (O: $7784.50; C: $8986.53; P = 0.5286), mortality (O: 11.40%; C: 13.18%; P = 0.2678), or ICU length of stay (LOS) (O: 4.85 ± 6.23; C: 4.37 ± 4.94; P = 0.0795).
CONCLUSIONS: Patients in the closed-collaborative cohort had similar clinical outcomes despite having a sicker cohort of patients. We hypothesize that the closed-collaborative ICU model was able to maintain equivalent outcomes due to the dedicated multidisciplinary critical care team caring for these patients. Further research is warranted to determine the optimal model of ICU care for trauma patients.
METHODS: A retrospective review of trauma patients in the SICU from August 1, 2015 to July 31, 2019 was performed. Patients were divided into those admitted prior to August 1, 2017 (the \"open\" cohort) and those admitted after August 1, 2017 (the \"closed-collaborative\" cohort). Demographic variables and clinical outcomes were analyzed. Trauma severity was assessed using injury severity score (ISS).
RESULTS: We identified 1669 patients (O: 895; C: 774). While no differences in demographics were observed, the closed-collaborative cohort had a higher overall ISS (O: 21.5 ± 12.14; C: 25.10 ± 2.72; P < 0.0001). There were no significant differences between the two cohorts in the incidence of strokes (O: 1.90%; C: 2.58%, P = 0.3435), pulmonary embolism (O: 0.78%; C: 0.65%; P = 0.7427), sepsis (O: 5.25%; C: 7.49%; P = 0.0599), median ICU charges (O: $7784.50; C: $8986.53; P = 0.5286), mortality (O: 11.40%; C: 13.18%; P = 0.2678), or ICU length of stay (LOS) (O: 4.85 ± 6.23; C: 4.37 ± 4.94; P = 0.0795).
CONCLUSIONS: Patients in the closed-collaborative cohort had similar clinical outcomes despite having a sicker cohort of patients. We hypothesize that the closed-collaborative ICU model was able to maintain equivalent outcomes due to the dedicated multidisciplinary critical care team caring for these patients. Further research is warranted to determine the optimal model of ICU care for trauma patients.
摘要：
背景：重症监护病房（ICU）护理的优化会影响临床结果和资源利用。2017年，我们的外科ICU（SICU）采用了“封闭协作”模式。这项研究的目的是在我们的成人1级创伤中心收治的创伤手术患者队列中，比较封闭协作模型与先前开放模型中的患者结局。
方法：对2015年8月1日至2019年7月31日SICU的创伤患者进行回顾性分析。患者分为2017年8月1日之前入院的患者（“开放”队列）和2017年8月1日之后入院的患者（“封闭协作”队列）。分析人口统计学变量和临床结果。使用损伤严重程度评分(ISS)评估创伤严重程度。
结果：我们确定了1669例患者（O：895；C：774）。虽然没有观察到人口统计学差异，封闭协作队列的总体ISS较高(O:21.5±12.14;C:25.10±2.72;P<0.0001).卒中发生率两组间无显著性差异(O:1.90%;C:2.58%,P=0.3435),肺栓塞(O:0.78%;C:0.65%;P=0.7427),脓毒症(O:5.25%;C:7.49%;P=0.0599),ICU费用中位数（O：7784.50美元；C：8986.53美元；P=0.5286），死亡率(O:11.40%;C:13.18%;P=0.2678),或ICU住院时间（LOS）（O：4.85±6.23；C：4.37±4.94；P=0.0795）。
结论：封闭协作队列中的患者尽管有较病重的队列，但具有相似的临床结果。我们假设，由于专门的多学科重症监护团队照顾这些患者，封闭式协作ICU模型能够保持同等的结果。需要进一步的研究来确定创伤患者ICU护理的最佳模式。
方法：对2015年8月1日至2019年7月31日SICU的创伤患者进行回顾性分析。患者分为2017年8月1日之前入院的患者（“开放”队列）和2017年8月1日之后入院的患者（“封闭协作”队列）。分析人口统计学变量和临床结果。使用损伤严重程度评分(ISS)评估创伤严重程度。
结果：我们确定了1669例患者（O：895；C：774）。虽然没有观察到人口统计学差异，封闭协作队列的总体ISS较高(O:21.5±12.14;C:25.10±2.72;P<0.0001).卒中发生率两组间无显著性差异(O:1.90%;C:2.58%,P=0.3435),肺栓塞(O:0.78%;C:0.65%;P=0.7427),脓毒症(O:5.25%;C:7.49%;P=0.0599),ICU费用中位数（O：7784.50美元；C：8986.53美元；P=0.5286），死亡率(O:11.40%;C:13.18%;P=0.2678),或ICU住院时间（LOS）（O：4.85±6.23；C：4.37±4.94；P=0.0795）。
结论：封闭协作队列中的患者尽管有较病重的队列，但具有相似的临床结果。我们假设，由于专门的多学科重症监护团队照顾这些患者，封闭式协作ICU模型能够保持同等的结果。需要进一步的研究来确定创伤患者ICU护理的最佳模式。
