Articles: intensive-care-units.
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Nursing in critical care · Jul 1996
A phenomenological study of ethical decision-making experiences among senior intensive care nurses and doctors concerning withdrawal of treatment.
The study compared and contrasted the experiences of senior doctors and nurses ethical decision making concerning the withdrawal of treatment. Doctors generally took the primary role in ethical decision making, leaving nurses acting as information brokers. ⋯ Doctors and nurses needed to come to terms with withdrawal of treatment. A model of communication which will enhance collaborative, multidisciplinary ethical decision making is suggested.
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Critical care clinics · Jul 1996
ReviewDoes a full-time, 24-hour intensivist improve care and efficiency?
This article reviews the hypothesis that staffing with full-time intensive care physicians leads to improvements in the management of ICUs and in the outcome for ICU patients. Variations in the professional organization of critical care units in the United States are discussed. The advantages and disadvantages of open, closed, and transitional (comanagement) ICU organizational structures are presented.
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We investigated the impact of alcohol-related medical emergencies on health care utilization in an inner city hospital medical intensive care unit (ICU). Data from 200 consecutive admissions to the medical ICU were collected prospectively. The major reason for each patient's admission to the ICU was recorded and the causal relationship between alcohol abuse and the admission diagnosis was determined. ⋯ In conclusion, we demonstrated that alcohol-related admissions are common in inner city hospital ICUs and consume considerable hospital resources. The treatment of these patients is costly, with hospitalization being essentially non-curative. In this era of health care reform, more effective primary and secondary preventative measures are required to control this pervasive health care problem.
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Critical care medicine · Jul 1996
Cost accounting of adult intensive care: methods and human and capital inputs.
To cost adult intensive care by determining inputs to production, resource consumption per patient, and total cost per intensive care unit (ICU) stay. ⋯ In order to develop strategies aimed at cost containment, it is first necessary to undertake a thorough examination of cost drivers. This detailed cost-accounting study determined inputs to production, resources consumed by individual patients, and costs incurred during ICU stay.
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This study examined the validity of medical-record-based nursing assessment and monitoring of signs and symptoms (nursing surveillance) in predicting patients who were admitted to ICUs and those admitted to non-ICUs. The association of this assessment and monitoring with differences in an intermediate patient outcome, instability at discharge, was also explored. Patients admitted to either setting with a diagnosis of acute myocardial infarction, cerebrovascular accident, congestive heart failure, or pneumonia, were included in the study. ⋯ ICU patients (n = 3969) were found to have a longer length of stay and to be sicker on admission than non-ICU patients (n = 7277). Overall, patients in the ICU received significantly higher nursing assessment and monitoring of signs and symptoms scores than non-ICU patients. Nursing assessment and monitoring of signs and symptoms scores were lower for patients discharged with greater instability for three of the four diseases (cerebrovascular accidents, congestive heart failure, and pneumonia).