A team of researchers at Seoul National University Bundang Hospital (SNUBH) has found that a closed intensive care unit (ICU) design with trained specialists in the ICU can reduce the mortality rate of critically ill patients by an average of 22 percent. 

Professors Oh Tak-kyu (left) and Song In-ae of Anesthesiology and Pain Medicine at SNUBH found that a closed intensive care unit (ICU) design with trained specialists in the ICU can reduce the mortality rate of critically ill patients by an average of 22 percent.  (Credit: SNUBH)
Professors Oh Tak-kyu (left) and Song In-ae of Anesthesiology and Pain Medicine at SNUBH found that a closed intensive care unit (ICU) design with trained specialists in the ICU can reduce the mortality rate of critically ill patients by an average of 22 percent.  (Credit: SNUBH)

A dedicated specialist system is designed so that specialists in critical care medicine reside in the ICU during daytime hours on weekdays for at least five days a week, and can provide expert advice on the patient's condition to quickly determine and diagnose the patient. 

The Korean Society of Critical Care Medicine (KSCCM) first introduced the specialist system in 2009 and the number of dedicated specialists stood at 1,774 in Korea as of 2022.

Since 2015, the government has provided a compensation system for hospitals with ICU specialists but the related compensation is small prohibiting hospitals from hiring these experts. According to the third assessment of ICU adequacy in Korea in 2020, the average number of ICU beds per dedicated specialist was 22.2, about three times higher than the 7.5 recommended by U.S. guidelines.

Accordingly, Professors Song In-ae and Oh Tak-kyu of Anesthesiology and Pain Medicine at SNUBH conducted a study to compare critical care mortality rates with and without dedicated specialists. Using data from the National Health Insurance Service (NHIS), the study was conducted on 1,147,493 patients hospitalized in intensive care units from 2016 to 2019 and 13,103 patients hospitalized in intensive care units due to Covid-19 from October 2020 to December 2021.

The addition of patients with severe Covid-19 to the study population investigated the importance of dedicated specialists during a pandemic like Covid-19. Mortality was classified based on patients who needed oxygen therapy (level 1) or those who required vasopressors and dialysis or extracorporeal membrane oxygenation (ECMO) (level 6) and those who were diagnosed with acute respiratory distress syndrome (ARDS).

Consequently, the proportion of critically ill patients treated by specialists was 42 percent between 2016 and 2019 and 20.2 percent between 2020 and 2021.

Overall, ICU mortality was reduced by an average of 22 percent and one-year mortality was reduced by 15 percent for patients who received care from a dedicated specialist compared to those who did not receive care from a dedicated specialist. 

Additionally, mortality among patients admitted to the ICU due to Covid-19 was reduced by an average of 28 percent, with a 36 percent reduction in mortality among patients with acute respiratory distress syndrome (ARDS), which has a particularly high mortality rate due to poor disease prognosis.

These findings suggest that the employment of dedicated specialists is necessary to improve the short- and long-term survival of patients, said the researchers.

The study was first published in the Annals of Intensive Care and  the following study adding the Covid-19 patient cohort was published in the Journal of Intensive Care.

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