On the delivery of intensive care

A 12-bed medical-surgical intensive care unit in a provincial, university-affiliated teaching hospital had 810 admissions during an 18-month period. Most patients were admitted under the care of a family physician. Quality care in the ICU was maintained by the efforts of dedicated unit managers, specialists and house staff. The overall mortality in the ICU of 8.1%, when added to the post-ICU mortality of 2.7% (giving a total hospital mortality of 10.8%), compares favourably with the best reported figures. Strong emphasis on selection of patients with potentially reversible disease, prompted in part by the limited facilities, may have played a role in yielding such favourable statistics. It is possible to retain participation of all members of the health care team during the brief phase of severe illness requiring intensive care.