Articles: intensive-care-units.
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Although the aged occupy a high proportion of critical care beds nationwide, few multicenter studies have been undertaken to specifically determine physician attitudes toward the elderly in a critical care setting. We attempt to determine the importance of patient age as a factor in the admission of acutely ill medical patients to critical care units. ⋯ Age is a factor considered by physicians in the admission of acutely ill medical patients to critical care units. Other medical and social factors, however, can affect the impact of patient age on treatment decisions. Further study and discussion are needed to clarify the appropriate role of age and other factors in critical care unit admissions.
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A mathematical model revealing the relationships between bed capacity, average patient admission rate, average patient length of stay, utilization rate, and overfill rate in intensive care units is developed and explained. Mathematical model predictions are compared to predictions of two kinds of discrete event intensive care unit simulations and to data from a variety of real intensive care units. ⋯ There is no significant (p < 0.05) difference between measured utilization and overfill rates assessed in actual intensive care units, the rates obtained by discrete event simulations, and the rates predicted by the intensive care unit model. The intensive care unit census model can enhance rational determination of intensive care unit bed and staff requirements.
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This article presents an interesting case where nurses touched a family member to escort her out of the ICU against her wishes. In the case analysis, the nurse attorney author reviews the ethical and legal issues in this case.
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Critical care medicine · May 1995
Review Comparative StudyA review of cost studies of intensive care units: problems with the cost concept.
To study methods for costing hospital services, specifically in relation to multi-unit studies of activity, case mix, severity of illness, outcome, and resource use in adult intensive care units (ICUs). ⋯ The methodologies for costing ICU therapy are flawed and fail to provide correct answers. In most studies, the study question is not adequately specified and the cost concept used in the studies is not tailored to the purposes of the study. Standardizing the cost model would lead to better, faster, and more reliable costing. This standardized cost model should not be rigid, but adaptable to different decision situations. A decision tree or taxonomy is proposed as a way toward better costing of ICU activity.
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We performed a prospective study in our teaching hospital to determine the demand for a High Dependency Unit where none had existed before. An admission criteria protocol was designed for medical and surgical patients and this was used in an intense surveillance of 22 acute wards over 2 weeks. It was predicted that a high dependency unit of eight beds would operate to capacity 50% of the time. An analysis of this type over a short period of time using similar admission criteria could be used to assist in the prediction of the necessary size of a High Dependency Unit facility in any hospital.