Adult intensive care in an environment of resource restriction: how should the unit director respond?

Adult intensive care touches the lives of very few while consuming a disproportionately high level of resources. To survive in the future environment of resource restriction and accountability, the unit director must rapidly acquire a wide range of professional management skills. The intensive care unit director must be able to demonstrate to colleagues, health managers and the community that the large amount of resources provided to intensive care, and the remarkable freedom given to intensivists to use those resources, are justified in terms of compassionate evidenced-based care, efficiency, efficacy and appropriateness. While many outcomes may be subjected to audit, intensive care units must publish minimal performance data indexed to severity of illness and including their mortality, hospital mortality and length of stay and an overall indicator of patient acuity to identify patients at low risk who need not be admitted to an expensive intensive care bed.