Organisation and Management of Intensive Care

From the viewpoint of a health economist, the intensive care unit (leU) is a particularly fascinating phenomenon. It is the epitome of "high-tech" medicine and frequently portrayed as the place where life-saving miracles are routinely wrought. But the popular imagina tion is also caught up in the darker side, when agonizing decisions have to be made to avoid futile and inhuman continuation of expen sive treatments. My analytical interests led me to approach these issues by asking what the evidence tells us about which leu activities are very bene ficial in relationship to their costs and which are not. This quickly translates into a slightly different question, namely, which patients are most appropriately treated in an leu and which not. Unfor tunately, it is very hard to answer these questions because it has pro ved very difficult to investigate these issues in the manner which is now regarded as the "gold standard:' namely by conducting rando mized clinical trials or alternative courses of action. I think this is a pity, and I am not at all convinced that it would be unethical to do so in many cases, because there is wide variation in practice and ge nuine doubt as to which practices are best -the two conditions that need to be fulfilled before such a trial is justifiable.

Klappentext

This book presents the prospective multidisciplinary analysis of intensive care units in Europe from a health services research perspective. The hypothesis examined was that variables of the non-clinical management and organisation of intensive care units do influence the outcome of patient care. The research work was done by teams of various disciplines such as medicine, nursing, health services research, occupational psychology, economics, organisation, methodology, and statistics. The work was divided into 6 substudies: patients and facilities, organisation, personnel, culture, finances, and observational field work. Each substudy is presented as an independent approach to the ICU as a health care subsystem. The book is aimed at health care authorities and hospital management.

Inhalt
EURICUS-I: Introduction.- 1 Study Design.- 2 Study Results.- 3 Integration of Substudies.- 4 Conclusions.- 5 Recommendations.- 6 Field Work.- 7 Substudies.- 8 Highlights on the EURICUS-I Data.- III.- Participants in EURICUS-I.