Critical Care Plus: Trauma-Specific ICU Helps Boost Quality
Better outcomes, reduced costs, and LOS achieved
While some have long suspected that a closed trauma intensive care unit (TICU) would improve clinical outcomes and reduce costs as well as lengths of stay (LOS), until recently, no one had quantified results to support that hypothesis.
In what it claims is a first-of-its-kind study, the University of Alabama at Birmingham (UAB) has demonstrated that its trauma ICU, opened in 1998, has achieved all of those goals.1
The study followed 204 trauma patients—144 treated in the surgical ICU (SICU) between June 1, 1996, and Jan. 4, 1998, and 60 treated in the TICU between Jan. 5, 1998, and July 1, 1998. The findings include the following:
- Patients treated in the TICU had a median of 48 ventilator hours, compared with 63 hours for patients treated in the SICU.
- The prevalence of cardiovascular system failure was significantly lower in the TICU (21.3%) compared with the SICU (39.0%).
- The prevalence of renal system failure was 1.6% in the TICU and 12.3% in the SICU.
- There was a lower tendency for the TICU patients to experience at least one infection (49.2% vs. 59.7%).
- The overall hospital LOS was 15.6 days for TICU patients, compared with 22.3 days for SICU patients.
- The overall cost savings of the TICU were calculated at $314,520 for its first six months of operation.
"In many hospitals, critically ill trauma patients are admitted to a general purpose surgical ICU," notes Gerald McGowan Jr., MS, PhD, assistant professor with the epidemiology and surgery departments at UAB. "Our study showed that trauma patients did far better when admitted to a closed’ trauma-specific ICU—one with individual patient rooms managed by surgeons, nurses, and other professionals highly trained in trauma critical care."
Very Special Needs
Trauma patients have special needs that require a specialized ICU, McGowan notes. "They’re not necessarily sick for a long time. One day they’re doing well; the next day they’re not," he explains. "An acute event affects their lives; you’re looking at a completely different type of disease."
The trauma surgeons at UAB designed the TICU specifically to meet those unique needs. The unit has 12 beds separated by permanent floor-to-ceiling partitions, including six fully enclosed rooms with individual entry doors. Each room is equipped with a sink.
"The point being made was that the training and the resources to take care of a trauma patient in an ICU environment do differ," McGowan says. "The thought was that if you could get together a cohort of people who had that focused training and then give the house staff—residents, fellows, and interns—a working environment tailored to patients who were acutely injured, it would provide a more focused experience for them."
The study was conducted to evaluate this change. "You propose these things on the grounds that they seem to make sense clinically, but there was not any existing literature on the topic," McGowan explains. "So the reasonable thing to do was to give us the money, get the trauma ICU up and operational, and then I’ll tell you if it worked. In other words, if you want to argue about whether the resources were well spent, let’s do it with the data in front of us."
Leadership Support Key
Of course, that meant investing money in the trauma ICU before it could be proven to be cost-effective. That’s why McGowan cites "having the leadership of the institution work with the clinical staff" as one of the keys to the unit’s success.
The other key contributing factor, he says, was the staffing—having people who were trained to deal specifically with this type of population. Nevertheless, additional staffing costs were restricted to nurses. The trauma/surgical critical care-attending surgeons, three of whom had added qualifications in surgical critical care, managed all trauma patients.
Additional staff costs were not included when savings were calculated, McGowan concedes. Does he have any idea of what the center’s true return on investment might be? "You could probably sit down with a calculator and maybe make some guesstimates, but it’s really hard to calculate all of your savings," he says. "For example, if you look at the reduction in mortality, what is a life worth? In addition, you would also need to take a new look at the SICU. It’s likely that some beds were freed up. Can it now run more efficiently? I suspect so."
1. Park CA, McGowan Jr. G, Smith DR, et al. Trauma-specific intensive care units can be cost effective and contribute to reduced hospital length of stay. Am Surg. 2001;67:665-670.