open vs closed university model.

[hmhheartmender]

Hello All,

I currently work in a unit that is struggling with the question of being an open vs. closed unit model. By closed I mean "drop your patient off at the door and we will let you know when they are ready to be picked up". Currently our patients are followed by intensivist/cardiologist and the teaching interns and residents but it is rather haphazard. We are a mixed ICU/CCU that follows the patients but questioning whether or not we are conforming to all the guidelines of supervision. The director would like to propose a university model to administration but is being met with much resistance from attendings. The words "patient stealers have even come in to play. The nursing staff would also like to see a closed model as well as we are completly tired of the fragmentation of care. Does anyone out there have comments and opinions and being open or closed and what were the positives and drawbacks of each. I would love to hear them!!

[Jolie, BSN]

I think I understand your question, and think I have experience from a different department that is similar to your situation.

I worked at a hospital that was upgrading maternity services, and opened a NICU. They hired on a group of neonatologists to provide 24 hour in-house coverage for all C-sections, high-risk deliveries and admissions of sick newborns. Administration mistakenly believed that the private pediatricians would welcome this group of physicians since they would no longer need to leave their offices during the day or be called in at all hours of the night to attend deliveries or admit sick newborns. They would also no longer have to provide in-hospital care to newborns whose parents had selected pediatricians who didn't have privileges at our hospital.

Administration got it all wrong. The private pediatricians had a fit over losing the revenue of these patients, and demanded admitting privileges to the NICU. After much debate, it was granted on the condition that the private pediatricians be available 24/7 to the NICU nursing staff, just as the neonatologists were. That meant that if we had an admission at 2am, they couldn't ask the neonatologist to do the admission and then turn the baby over to the pediatrician in the am. If we had trouble with IV starts at 5am, they had to come in and start a PICC line (Which few knew how to do). If we had critical lab values at 12 midnight, they had to respond. If there was a delay in a scheduled C-section that kept them away from their office for 2 hours during the day, so be it. This didn't last very long. The quickly wearied of being on call 24/7, and came to realize that it was not cost-effective for them to leave an office full of patients to come in and spend hours with one infant. They cried "Uncle" and gave up their NICU admission privileges pretty quickly.

[elizabells, BSN, RN]

That is so awesome, Jolie. I wish I could have seen that.