Ugeskrift for laeger
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Ugeskrift for laeger · Feb 2007
Comparative Study[Capacity problems in Danish intensive care units?].
There are documented capacity problems in Danish ICUs. The indications for intensive care have increased in the last decade without any increase in the number of ICU beds. ⋯ Possible solutions: 1) an increase in the number of ICU beds, 2) re-organization of Danish ICUs into larger units and 3) creation of "step-down"-units. Intensive care is a costly area in the healthcare system, where there must be distinct guidelines for visitation and use of expensive medicine and advanced technology.
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Ugeskrift for laeger · Feb 2007
Comparative Study[Diagnosis Related Groups in intensive care units--cost model for critically ill patients].
The actual contribution of intensive care to total hospital costs in Denmark has yet not been completely identified. In order to adapt the DRG system to better reflect the actual costs of the intensive care units (ICUs) the original primarily diagnosis-based DRG system was modified in order to be based on ICU-related procedure codes. A new DRG system for ICU patients was developed and implemented in 2004. ⋯ As a result there has since been a qualitative improvement in the documentation of the activities in the ICUs. The information categorized according to the new ICU DRG-groups allows for better differentiation of patients, and might lead to an increasing understanding of the quality of healthcare provision in the ICU by the use of comparisons in a database. A meaningful cost comparison between intensive care units can only be made by combining activity with quality of delivered care.
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Ugeskrift for laeger · Feb 2007
[What is intensive care medicine? Multidisciplinary intensive care units].
Intensive care medicine is described from a multidisciplinary point of view. The term "multidisciplinary" is used, although "multispeciality" may be more appropriate. ⋯ Intensive care medicine is conducted in the high-technology environment of intensive care units. These are further classified according to their own competency base as well as the level of the hospital in which they are situated.
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Intensive care contributes to a substantial part of health care expenses. Admission to intensive care units is associated with a high mortality rate and a high risk of long-term disability. ⋯ Lack of knowledge regarding the use of intensive care and long-term outcome as well as the effectiveness and adverse effects of intensive care impede a systematic and evidence-based development and quality improvement. An initiative to establish a Danish national clinical database for intensive care has been launched.
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SIRS, sepsis, severe sepsis, and septic shock are complex syndromes ranging from early signs of infection to multiple organ dysfunction and shock. The reported incidence of sepsis is as high as 35% with mortality rates from 27% to 54% in sepsis and septic shock, respectively. Though aetiology and pathogenesis can vary significantly between septic patients, emphasis has been made to preserve sepsis as a clinical diagnosis ensuring high sensitivity. Since 2001 several new treatment strategies have been implemented, but early diagnosis, optimization of haemodynamics, rapid identification of pathogen and adequate antibiotic treatment are still of the highest importance.