Articles: intensive-care-units.
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Critical care medicine · Mar 1987
Clinical characteristics and resource utilization of ICU patients: implications for organization of intensive care.
We reviewed the clinical characteristics and resource utilization of 391 medical (M) and 315 surgical (S) ICU patients. In general, MICU patients had more physiologic derangement, as determined by the admission, maximal, and average acute physiology scores (APS). SICU patients had more frequent therapeutic interventions as measured by admission, maximal, and average therapeutic intervention scoring system values. ⋯ In contrast, 83% of patients with APS greater than 10 had considerable intensive interventions. These patients required mechanical ventilation, invasive monitoring, and vasoactive drugs more than twice as often as patients with lower APS scores. Consideration should be given, therefore, to the organization of ICUs according to the patient's severity of illness.
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Critical care medicine · Mar 1987
A computer simulation program to facilitate budgeting and staffing decisions in an intensive care unit.
ICUs have unique problems in choosing their best staffing levels for direct patient care because each unit's total patient needs per shift, quantitated in acuity points, vary widely. We devised a computer program to simulate our 12-bed medical/cardiac ICU workload and staffing system. ⋯ Using the model, we considered financial concerns, quality of care issues, and staff working preferences and determined that our best staffing level would be based on 5.5 direct FTEs per shift. The stimulation analysis is straightforward, flexible, adaptable, and easy to update and use.
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User "friendly" computers are becoming available for increased usage in the medical arena. The Surgical Intensive Care Unit (SICU) has a large number of items to identify, quantify, manage, and record frequently, often on a continuing basis. At the Palo Alto Veterans Hospital, a program has been developed (A. ⋯ Fewer laboratory studies such as blood gas determinations are required. Trending of information is critical in making appropriate plans of care. Twenty patients with a variety of surgical problems have been evaluated by utilizing a bedside computer.
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Since intensive care is expensive and has limited efficacy, its use should be reserved primarily for patients with acute, reversible illnesses. Although age is related to ICU mortality, more important predictors of ICU outcome are severity of the acute illness, the admitting diagnosis, and previous health status. Thus, age should not be the sole factor considered prior to ICU transfer or the initiation or denial of resuscitative efforts. Geriatric physicians should prospectively develop individualized plans for each of their patients based upon the patients' wishes after a discussion of diagnosis, prognosis, and the likely efficacy and side effects of the available treatments.