The impact of organisational change on outcome in an intensive care unit in the United Kingdom.

<bold>Objectives: </bold>To study the change in outcome for patients admitted to an intensive care unit following the establishment of a team of resident medical staff and a change from an "open" to a "closed" organisational format.<bold>Design: </bold>Database review of prospectively collected data.<bold>Setting: </bold>Intensive care unit of a postgraduate teaching hospital.<bold>Subjects: </bold>1134 admissions to the intensive care unit over a 3-year period, of whom 476 (42%) followed elective surgery.<bold>Main Outcome Measure: </bold>Hospital mortality corrected for illness severity by using the APACHE II scoring system.<bold>Results: </bold>Crude hospital mortality fell from 28% before the changes to 20% afterwards (P = 0.01). With correction for case-mix factors, the probability of death after the changes was reduced by almost half (OR 0.51; CI 0.32, 0.82, P = 0.005).<bold>Conclusion: </bold>A "closed" format of organisation of the delivery of care may result in improved outcomes for patients admitted to intensive care units. [ABSTRACT FROM AUTHOR]