Articles: intensive-care-units.
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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
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.
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Critical care clinics · Jul 1993
ReviewCritical care management in the 1990s. Making collaborative practice work.
The creation of a partnership, the hallmark of true collaborative practice, is an ongoing, dynamic process. It demands commitment, energy, and creativity. It is learned and therefore must be role modeled. ⋯ We must continue to broaden our collaborative efforts to extend from the patient care arena into the realms of education, research, and administration. It is up to each of us and each of our colleagues to work every day toward a more collaborative practice environment. By empowering each other, we can put into place a collaboration which "works jointly with others in intellectual endeavors" rather than one which merely "cooperates with an enemy force."
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Critical care clinics · Jul 1993
Review Historical ArticleOrganization and management of critical care systems in unconventional situations.
Critical care medicine is a field of medicine using the highest concentration of expensive diagnostic and life-support technology for the benefit of a single individual. Conventional use of this resource and specialty is clearly understood, despite the fact that it is not necessarily comparable among different institutions. Some of the major issues in using critical care as a medical tool during extraordinary stress on the hospital, and the potential for using it in unconventional environments outside an established institution, have been reviewed. It is clear that the expertise and multidisciplinary approach can be of great use in disaster response, and a national effort toward integrating critical care into overall medical response is in progress.
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This discussion has furnished a personal view of some of the features involved in managing a busy surgical ICU. Experience has provided the reference frame rather than an extensive literature search and associated bibliography. Physician involvement in ICU management depends on the character of the institution and the ability of the director to influence physician, nursing, and ancillary staff behavior by force of personality rather than by relying on universally accepted behavioral covenants. ⋯ Clinicians traditionally have focused on individual patients, and this approach has led to many improvements in care. The next challenge facing the ICU management team will be to organize the process of patient care that will ensure the best possible individual outcome while promoting general efficiency of the available resources to function for all. Physician and nurse managers will be co-responsible for adjudicating a complex, costly, and vital hospital resource; the price of failure is unacceptable.(ABSTRACT TRUNCATED AT 400 WORDS)