Shock Trauma Unit Could Serve as National Model

A novel unit created to care for critically ill patients significantly sped access to specialized care.

A novel unit created to care for critically ill patients at the University of Maryland School of Medicine (UMSOM) and the University of Maryland Medical Center (UMMC) significantly sped access to specialized care, a new study published online February 23, 2016, in the Journal of the American College of Surgeons reports. The unit, the nation’s first Critical Care Resuscitation Unit (CCSU), is a 6-bed, short-stay intensive care unit (ICU) located within the Shock Trauma Critical Care Tower at UMMC. It is staffed 24/7 by physicians and nurses with broad and diverse critical care experience.

Thomas M. Scalea, MD, and colleagues said CCSU at UMMC was designed as a unit midway between an emergency department (ED) and ICU similar to their Trauma Resuscitation Unit but for non-trauma patients. This design was meant to address the fact that while organized trauma systems are in place for transferring patients from the scene of an accident to a specialized trauma center, no formal systems have been in place for transferring non-trauma patients in need of often life-saving care. Patient access to specialty care in the academic medical center setting is largely dependent on the availability of ICU beds in the receiving hospital. Without an open bed to receive the patient, wait times for transfers to academic medical centers with highly specialized facilities can mean the difference between life and death.

During the first full year of operation of the new unit, for the subset of adult patients admitted for critical care, transfers increased 64.5% compared with a previous year and patients arrived in nearly half the time (129 minutes vs 234 minutes).

“It has been phenomenally successful in its intended mission to serve critically ill patients, and we believe it should serve as a model for other institutions,” said Dr Scalea.

He noted that prior to the new unit being built, despite UMMC’s operation of an interhospital call center for the transfer of critically ill patients, patients needing immediate critical care were sometimes unable to be transferred if a specialized ICU bed was not available, or transfer times were longer than desired.

In addition to decreasing time to arrival and increasing transfers, the CCRU also significantly decreased the percentage of lost admissions from 25.7% to 14% in this subset of transfer patients requiring critical care.

The team said that they admitted nearly 1000 additional transfer patients in the first year alone since opening the CCRU, so that adding 6 beds and borrowing practices honed in the Shock Trauma Unit made their entire system more efficient. More research will be done to follow up on this initial report.

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