Articles: critical-care.
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Critical care medicine · Dec 1994
Joint position statement: essential provisions for critical care in health system reform. Society of Critical Care Medicine. American Association of Critical Care Nurses.
Production of a statement defining the essential provisions of health system reform as determined by the Society of Critical Care Medicine (SCCM) and the American Association of Critical-Care Nurses (AACN). This document is the only nurse-physician joint statement to result from the 1994 health system reform debate. ⋯ SCCM and AACN agreed that health system reform should ultimately achieve universal coverage, access, control cost, and should improve the quality of care. SCCM and AACN endorsed improved access to and coverage for preventive care services. Recognizing that critical illness and injury cannot be prevented entirely, SCCM and AACN agreed that a reformed system must foster improved care of the critically ill and injured as described below.
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To identify predictors of 6-month mortality known before emergent admission to intensive care (IC) and to describe obstacles to the use of patient preferences in emergency triage decisions. ⋯ Patients with poor performance status or very advanced age have increased mortality within 6 months of emergent triage to IC. Mental status changes, absence of advance directives, and time constraints are common barriers to communication of patient preferences at the time of triage. Primary care physicians need to elicit and record patients' preferences before the time of emergent decisions about IC.