Articles: intensive-care-units.
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Intensive care is being scrutinized as a major factor in increasing health care costs. We examined 404 consecutive admissions to the medical ICUs at a university medical center to study patterns of consumption of ICU resources and the proportion of resources used by patients admitted for monitoring only. ⋯ Reducing the number of patients admitted for monitoring will have a relatively small impact on hospital charges. Since over 70 percent of the high-cost patients died, improved understanding of prognosis and better physician-patient communication may substantially reduce the proportion of critical care resources expended on futile treatment.
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Critical care medicine · Mar 1991
Outcome following prolonged intensive care unit stay in multiple trauma patients.
To describe the hospital course and outcomes of trauma patients requiring ICU stays greater than 30 days and the charges they incur. ⋯ Length of ICU stay was most closely associated with the need for mechanical ventilation. The presence of premorbid illness, age greater than 65 yr, and organ dysfunction was associated with increased mortality. Although trauma patients requiring prolonged ICU stays utilize many resources, the ultimate outcome may be fairly good.
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The incidence and types of organisms present in the vacant ports of 424 three-way taps were studied. The taps were used in 50 children in ICU. ⋯ The organisms cultured were staphylococci, klebsiella, streptococci, bacilli and fungi. While there was no marked difference in the growth rate of organisms in three-way taps used in intravenous, intra-arterial and central venous lines, growth rate increased with duration of use.
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Critical care units have proliferated over the past three decades and the cost of care in these units has increased dramatically during that period. These units have flourished despite a surprising lack of adequate data to support their overall efficacy, and indeed a number of studies suggest that many patients admitted to these units are either too ill or too healthy to benefit. Dr Luce reviews recent changes in the organization and delivery of critical care and argues that the utilization and quality of critical care units can be improved through a combination of strategies. ⋯ In addition, although nominally eschewing the use of "formal" rationing policies, he advocates the development of admission and discharge policies to guide physicians during periods of low bed availability. Finally, he advocates greater leadership roles for professional critical care unit directors. This final suggestion has great merit but, as Dr Luce recognizes, a heightened role for critical care unit directors raises ethical and legal issues about the autonomy of both patients and physicians that need to be explored thoroughly.
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The results of the American Association of Critical-Care Nurses Demonstration Project support the contention that high quality critical care nursing can be provided to patients at a reasonable cost. In addition, the data refute the notion that elements influenced by nurses--supplies and nursing care--are the most costly portion of the total hospital charge.