• Soumitra R Eachempati, Lynn J Hydo, and Philip S Barie.
• Department of Surgery, NewYork-Presbyterian Hospital, New York Weill Cornell Center, and Weill Medical College of Cornell University, New York 10021, USA. seachempati@surgery.med.cornell.edu
• Arch Surg Chicago. 2004 Mar 1; 139 (3): 315-9.

HypothesisMany surgical intensive care units (SICUs) face bed shortages for acutely ill patients that may result from a large proportion of bed occupation by chronically ill patients. We hypothesized that the introduction of a new intermediate care or step-down unit (SDU) managed by surgically trained intensivists would allow the admission of more acutely ill patients while maintaining satisfactory outcomes.DesignProspective retrospective comparison of SICU patient populations before and after the introduction of an SDU.SettingThe SICU of New York-Presbyterian Hospital, New York Weill Cornell Center, a university hospital containing a level I trauma center.Patients And InterventionsAll patients in the SICU admitted from August 1, 1996, through June 30, 1997, were SICU patients prior to the introduction of the SDU. Patients admitted from August 1, 1997, through June 30, 1998, were SICU post-SDU patients, and SDU patients included those admitted to the SDU from August 1, 1997, through July 1, 1998.Main Outcome MeasuresFor each of the 2 eras, patients were compared for age, sources of admission, Acute Physiology and Chronic Health Evaluation (APACHE) II and III scores, unit length of stay, and mortality. Other data collected included origin of admission, nature of admission, and diagnosis.ResultsSix hundred sixty-six patients were admitted during the pre-SDU era, while a total of 1117 patients (619 SICU and 498 SDU patients) were admitted in the post-SDU era. After the introduction of the SDU, the mean (standard deviation) APACHE II scores of the SICU and SDU patients increased (14.2 vs 13.4, P =.04) without affecting mortality (6.0% in the post-SDU era vs 8.2% in the pre-SDU era, P =.07). The post-SDU era had a higher proportion of emergency admissions (42.3% vs 48.6%, P<.05) and interhospital transfers (7% vs 1%).ConclusionsOpening an SDU resulted in a significant increase in the overall severity of the SICU population. Creation of an SDU managed by surgically trained intensivists may optimize the use of a hospital's resources, permit the expansion of emergency or tertiary care services, and improve outcomes for critically ill surgical patients.

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