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Maintaining quality of care 24/7 in a nontrauma surgical intensive care unit.

Publication ,  Journal Article
McMillen, MA; Boucher, N; Keith, D; Gould, DS; Gave, A; Hoffman, D
Published in: The journal of trauma and acute care surgery
July 2012

Most surgical critical care literature reflects practices at trauma centers and tertiary hospitals. Surgical critical care needs and practices may be quite different at nontrauma center teaching hospitals. As acute care surgery develops as a component of surgical critical care and trauma, the opportunities and challenges of the nontrauma centers should be considered.In 2001, a new surgical critical care service was created for an 800-bed urban teaching hospital with a 12-bed surgical intensive care unit (SICU). Consults, daily rounds, daily notes, and adherence to best practices were standardized over the next 9 years for a team of postgraduate year-1 and -2 surgical residents, physician assistants and surgical intensivists. The Fundamentals of Critical Care Support course was given as basic introduction, and published guidelines for ventilators, hemodynamics, cardiac, infections, and nutrition management were implemented. A "beyond FCCS" curriculum was repeated every resident rotation. A 12-bed stepdown unit was developed for the more stable patients, mostly run by SICU physician assistants with SICU attending coverage. The first 5 years, night coverage was by the daytime intensivist from home. The last 4 years, night coverage was in-unit surgical intensivists or cardiac surgeons.Data for 13,020 patients drawn from 152,154 operations over 9 years is reported. Surgery grew 89% to 24,000 cases/year in 2010. Half the patients were general, gastrointestinal oncology, or vascular surgery. Ninety-two percent were perioperative. The 8% nonoperative patients were mostly gastrointestinal bleeding, abdominal pain, or pancreatitis. In the first year, annual SICU mortality decreased from an average of 4.5% the 5 previous years to 1.96% (2002) and remained 1.75% (2003), 2.1% (2004), 1.9% (2005), 1.5% (2006), 1.5% (2007), 2.2% (2008), 2.4% (2009), and 2.1% (2010).Annual mortality immediately improved at a busy nontrauma hospital with rapid, structured consultation by the SICU team, comprehensive daily rounds guided by critical care best practices, and daytime in-unit surgical intensivists. Low mortality was maintained over 9 years as surgery volume nearly doubled but did not improve further with 24/7 in-unit coverage by surgical intensivists and cardiac surgeons. The process of care in an SICU may be more important than 24 hour a day, 7 days a week intensivists.Therapeutic study, level II.

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Published In

The journal of trauma and acute care surgery

DOI

EISSN

2163-0763

ISSN

2163-0755

Publication Date

July 2012

Volume

73

Issue

1

Start / End Page

202 / 208

Related Subject Headings

  • Quality of Health Care
  • New York City
  • Humans
  • Hospitals, Teaching
  • Hospital Mortality
  • Hospital Bed Capacity, 500 and over
  • Emergency & Critical Care Medicine
  • Diagnosis-Related Groups
  • Critical Care
  • 4205 Nursing
 

Citation

APA
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ICMJE
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McMillen, M. A., Boucher, N., Keith, D., Gould, D. S., Gave, A., & Hoffman, D. (2012). Maintaining quality of care 24/7 in a nontrauma surgical intensive care unit. The Journal of Trauma and Acute Care Surgery, 73(1), 202–208. https://doi.org/10.1097/ta.0b013e31824ba4bf
McMillen, Marvin Allan, Nathan Boucher, David Keith, David Scott Gould, Asaf Gave, and Darryl Hoffman. “Maintaining quality of care 24/7 in a nontrauma surgical intensive care unit.The Journal of Trauma and Acute Care Surgery 73, no. 1 (July 2012): 202–8. https://doi.org/10.1097/ta.0b013e31824ba4bf.
McMillen MA, Boucher N, Keith D, Gould DS, Gave A, Hoffman D. Maintaining quality of care 24/7 in a nontrauma surgical intensive care unit. The journal of trauma and acute care surgery. 2012 Jul;73(1):202–8.
McMillen, Marvin Allan, et al. “Maintaining quality of care 24/7 in a nontrauma surgical intensive care unit.The Journal of Trauma and Acute Care Surgery, vol. 73, no. 1, July 2012, pp. 202–08. Epmc, doi:10.1097/ta.0b013e31824ba4bf.
McMillen MA, Boucher N, Keith D, Gould DS, Gave A, Hoffman D. Maintaining quality of care 24/7 in a nontrauma surgical intensive care unit. The journal of trauma and acute care surgery. 2012 Jul;73(1):202–208.

Published In

The journal of trauma and acute care surgery

DOI

EISSN

2163-0763

ISSN

2163-0755

Publication Date

July 2012

Volume

73

Issue

1

Start / End Page

202 / 208

Related Subject Headings

  • Quality of Health Care
  • New York City
  • Humans
  • Hospitals, Teaching
  • Hospital Mortality
  • Hospital Bed Capacity, 500 and over
  • Emergency & Critical Care Medicine
  • Diagnosis-Related Groups
  • Critical Care
  • 4205 Nursing