What do you understand by ‘open’ and ‘closed’ Intensive Care Units. Outline the advantages and limitations of each.
‘Closed’ ICUs are those managed by dedicated staff intensivists. Potential benefits include:
a) Being physically present allows for early identification and intervention when problems occur in order to help prevent disaster.
b) An intensivist's knowledge of relevant protocols and evidence-based practice will likely benefit patients.
c) Third, intensivists coordinate communication and collaboration with the patient, family members, other ICU clinicians and medical specialists to provide optimum and informed care.
d) Finally, the intensivists in the ICU manager to standardize processes of care, triage patients, effect timely discharges, and evaluate performance.
Intensivists staffing is associated with reduced length of ICU and hospital stay. Daily rounds by an ICU physician were associated with a 3-fold reduction in hospital mortality among abdominal aortic surgery patients, and reduced hospital length of stay and postoperative complications after esophageal resection. In addition, a recent review of ICU team models found that when intensivists actively managed all ICU patients, a further improvement in survival occurred. An estimated 162 000 lives could be saved annually if intensivists staffed all nonrural adult ICUs (data from USA).
However the term closed ICU implies a non collaborative, non inclusive approach, whilst in reality it is a team effort.
Several specialists involved consult, Physicians feel less excluded.
No single point of responsibility, patient coordination and communication, responsibility for bed management not clearly spelt out.
There is a good discussion of this in LITFL.
Advantages of a "closed" ICU
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