Articles: intensive-care-units.
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Revista médica de Chile · Oct 1990
Review[The admission and discharge criteria of a unit for critical patients].
Admission and discharge criteria for patients in an intensive care unit are controversial, especially in view of the fact that some patients derive no benefit from intensive care therapy while depriving others from a potential benefit. The general characteristics of patients in need of intensive care are discussed. Irreversibility of the underlying condition, the quality of "terminal patient" and other factors that may contraindicate admission to an intensive care unit are analyzed. Discharge criteria for patients not expected to derive further benefit from a prolonged stay in the unit are outlined.
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Critical care medicine · Oct 1990
Outcome prediction models on admission in a medical intensive care unit: do they predict individual outcome?
Prospectively acquired data from 941 patients staying greater than 24 h in a medical ICU were analyzed to determine the relevance of scoring on ICU admission by the following methods of outcome prediction: Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS), and Mortality Prediction Model (MPM). Analysis was performed separately for all patients (group A) and for a subsample (group B), obtained by excluding coronary care patients. Calculation of risk and classification of patients were carried out as recommended in the literature for MPM, APACHE II, and SAPS. ⋯ Application of APACHE II to diagnostic subgroups, using disease-adapted risk calculations, revealed marked inconsistencies between the estimated risk and the observed mortality. We conclude that the estimation of risk on admission by the three methods investigated might be helpful for global comparisons of ICU populations, although the lack of disease specificity reduces their applicability for severity grading of a given illness. The inaccuracy of these methods makes them ineffective for predicting individual outcome; thus, they provide little advantage in clinical decision-making.
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The Joint Commission on the Accreditation of Healthcare Organizations and the Society of Critical Care Medicine call on the physician medical director of the intensive care unit (ICU) to play an important role in admission and discharge decision-making. To assess nursing perception of the medical director's involvement in this decision-making, we analyzed data from a questionnaire administered at an annual ICU management conference to ICU nursing supervisors representing 101 hospitals and 137 ICUs. ⋯ In the 54 ICUs with full-time medical directors, nurses in approximately 30% of the units said that there was no nighttime availability of the medical director or designee. The data suggest that many ICUs lack physician leadership in ICU management and resource allocation.