Articles: intensive-care-units.
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In winter 1992/93 the working association for neurologic intensive care medicine (ANIM) undertook the continuation of a survey concerning the situation of the neurologic intensive care medicine in Germany which was first done in 1988. Altogether 51 intensive care units with in all 281 beds were questioned. 38 were located in the old, 13 in the new federal states. ⋯ The evaluation was done covering different questions like number of beds, type of clinic, number of doctors, number and training of nurses, vacant established posts in the nursing area, number and type of ventilation apparatus and monitors, possibility to measure intracranial pressure etc. In addition detailed data were given concerning the equipment of these intensive care units, the availability of major devices like CT or a neurosurgery department, the diagnosis of the patients treated on those intensive care units and the necessary average duration of staying.
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To determine the excess length of stay, extra costs, and mortality attributable to nosocomial bloodstream infection in critically ill patients. ⋯ The attributable mortality from nosocomial bloodstream infection is high in critically ill patients. The infection is associated with a doubling of the SICU stay, an excess length of hospital stay of 24 days in survivors, and a significant economic burden.
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A significant portion of health care resources are spent in intensive care units with, historically, up to two-fold variation in risk-adjusted mortality. Technological, demographic, and social forces are likely to lead to an increased volume of intensive care in the future. Thus, it is important to identify ways of more efficiently managing intensive care units and reducing the variation in patient outcomes. ⋯ Furthermore, units with greater technological availability are significantly more likely to be associated with hospitals that are more profitable, involved in teaching activities, and have unit leaders actively participating in hospital-wide quality improvement activities. The findings hold a number of important managerial and policy implications regarding technological adoption, specialization, and the quality of interaction among ICU team members. They suggest intervention "leverage points" for care givers, managers, and external policy makers in efforts to continuously improve the outcomes of intensive care.