Critical care clinics
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Critical care clinics · Jul 1993
ReviewIntensive care units in the triage mode. An organizational perspective.
Decisions to admit and discharge patients to and from the intensive care unit (ICU) when resources are scarce should be made according to the triage principle--that is, resources should be allocated based on the patient's ability to benefit from critical care. The ICU organizational structure and the constraints on decision-making processes are discussed in this article along with strategies for improvement in both areas.
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Critical care clinics · Jul 1993
ReviewUsing severity measures to describe high performance intensive care units.
This article describes the use of various scores and probabilities to clinically categorize patients in the adult intensive care unit. Some of the limitations of these severity measures are reviewed including variable definitions, timing of measurements, and whether models can be used for individual patients. Also, this article discusses how probability models may be used to compare similar types of intensive care units using standardized clinical and cost performance indices.
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Critical care practitioners are faced with ethical dilemmas every day. The increasing costs of health care coupled with the scarcity of resources, including critical care nurses, have created yet another ethical dilemma--rationing of health care. ⋯ This article identifies some of the ethical issues associated with the rationing of critical care and examines the foundations of ethical thought upon which such decisions can be based. Understanding the overall cost containment movement as well as the potential problems associated with medical gatekeeping will allow critical care practitioners to better deal with the ethical dilemmas of today as well as help them anticipate those that will arise in the near future.
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Critical care clinics · Jul 1993
ReviewRegionalization and categorization of critical care services.
Regionalized systems of care match the medical needs of individual patients to available resources. Hospitals are categorized based on their personnel and technologic resources. Triage guidelines, based on severity of disease, are developed to link patient types to hospital categorization levels. Regionalization requires major planning, publicity, and educational efforts to implement an ongoing coordination and continuous quality improvement to function.
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Critical care clinics · Jul 1993
ReviewAdmission, discharge, and triage in critical care. Principles and practice.
This article reviews the practices of admission, discharge, and triage to or from a special care unit and how they differ based on unit type and patient load. The need to solve the excess patient/insufficient resources dilemma is also addressed.