Improving the quality and utilization of critical care

Area of Science:

• Healthcare Management
• Critical Care Medicine

Background:

• Critical care units (CCUs) have proliferated over the past three decades, with a dramatic increase in associated costs.
• Despite expansion, there is a lack of adequate data supporting the overall efficacy of CCUs.
• Studies suggest many patients admitted to CCUs are either too ill or too healthy to benefit from this level of care.

Purpose of the Study:

• To review recent changes in the organization and delivery of critical care.
• To propose strategies for improving the utilization and quality of critical care units.
• To address the growing demand and cost associated with critical care.

Main Methods:

• Review of recent changes in critical care organization and delivery.
• Analysis of strategies to decrease demand or increase supply of critical care beds.
• Examination of institutional guidelines for treatment termination and admission/discharge policies.

Main Results:

• Proposed strategies include more efficient use of intermediate care units and clear institutional guidelines for treatment termination.
• Advocates for admission and discharge policies to guide physicians during periods of low bed availability.
• Suggests greater leadership roles for professional critical care unit directors.

Conclusions:

• Improving critical care unit utilization and quality requires a multi-faceted approach.
• Ethical and legal issues concerning patient and physician autonomy must be explored regarding expanded roles for critical care directors.