[How to evaluate and improve the effectiveness of intensive care]

Organizational problems regarding intensive care units (ICU) have become more and more significant. It is necessary to question the factors which can influence their effectiveness, and in this way ensure the high quality of intensive care. A grading of intensive care units through a quantitative method is necessary, and then a comparison of intensive care units with the same care level. In making a judgement of efficacy we need to follow the whole intensive care process, even after medical treatment. The time has come for establishing a national data base concerning the organization of ICU size, structure, technological capacity, staff, type and number of patients, mortality, length of stay, bed occupation, criteria for admission and discharge, interventions and procedures, etc. Future multidisciplinary units must employ educated and closely-specialized professionals. From the means of estimating the severity of sickness, the relationship between expected and real mortality should be used in judging efficacy. Measuring the burden of work, by using the TISS model, modified according to the conditions of our ICUs, will show the type and quality of the work done, and, in addition, can also determine cost. It points to a rational use of tests, the use of guidelines and recommendations and further recommends the making of our own protocols. Close professional links between ICUs are also necessary.