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December 11, 1981, Vol 246, No. 23 >
ARTICLE | December 11, 1981

The Range of Intensive Care Services Today FREE

William A. Knaus, MD; Douglas P. Wagner, PhD; Elizabeth A. Draper, MS; Diane E. Lawrence; Jack E. Zimmerman, MD
[+] Author Affiliations

Reprint requests to ICU Research, 2300 K Street NW, Washington, DC 20037 (Dr Knaus).


JAMA. 1981;246(23):2711-2716. doi:10.1001/jama.1981.03320230035021
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References

During the past 20 years, there has been a large increase in the number of hospitals with intensive care units (ICUs). To discover what services are provided to the growing number of ICU patients, we studied 624 consecutive admissions to a general surgical-medical ICU within a university hospital. We recorded the proportion of admissions and services involving intensive treatment as opposed to concentrated nursing care or monitoring. We found that for nearly half (49%) of the admissions and during two thirds (65%) of the nursing shifts, the emphasis was on close nursing care and observation, not intensive treatment. Of 252 patients admitted for monitoring, 216 (86%) never required active treatment before discharge. The average length of stay of these 216 patients was 2.1 days. If this distribution of services and admissions within one university hospital is also found at other institutions, it suggests that a substantial portion of ICU services may now be directed at monitoring stable, noncritically ill patients.

(JAMA 1981;246:2711-2716)

REFERENCES

1 +
Vaisrub S:  Laboratory testing—routine or on demand? JAMA 1980;;244:592.
2 +
Cullen DJ, Ferrara LC, Briggs BA, et al:  Survival, hospitalization charges and follow-up results in critically ill patients . N Engl J Med 1976;;294:982-987.
3 +
Turnbull AD, Carlon G, Baron R, et al:  The inverse relationship between cost and survival in the critically ill cancer patient . Crit Care Med 1979;;7:20-23.
4 +
Russell LB: Technology in Hospitals . Washington, DC, The Brookings Institution, 1979;.
5 +
Hospital Statistics: 1979 Edition . Chicago, American Hospital Association, 1979;.
6 +
Thibault GS, Mulley AG, Barnett GO, et al:  Medical intensive care: Indications, interventions, and outcomes . N Engl J Med 1980;;302:938-942.
7 +
Cullen DJ, Civetta JM, Briggs BA, et al:  Therapeutic intervention scoring system: A method for quantitative comparison of patient care . Crit Care Med 1974;;2:57-60.
8 +
Byrick RJ, Mindorff D, McKee L, et al:  Cost-effectiveness of intensive care for respiratory failure patients . Crit Care Med 1980;;8:332-337.
9 +
Cullen DJ:  Results and costs of intensive care . Anesthesiology 1977;;47:203-216.
10 +
Knaus WA, Zimmerman JE, Wagner DP, et al:  APACHE—acute physiology and chronic health evaluation: A physiologically based classification system . Crit Care Med 1981;;9:591-597.
11 +
Knaus WA, Thibault GE:  Intensive care units today , in McNeil BJ, Cravalho EG (eds): Critical Issues in Medical Technology . Boston, Auburn Press, to be published.
12 +
Knaus WA, Draper E, Lawrence DE, et al:  Neurosurgical admissions to the intensive care unit: Intensive monitoring versus intensive therapy . Neurosurgery 1981;;8:438-441.
13 +
Knaus WA, Wagner DP, Zimmerman JE:  A national comparison of ICU admissions , abstracted. Clin Res 1981;;29:321.
14 +
Draper EA, Wagner DP, Knaus WA:  The use of intensive care: A comparison of a university and community hospital . Health Care Financing Rev , to be published.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Vaisrub S:  Laboratory testing—routine or on demand? JAMA 1980;;244:592.
2 +
Cullen DJ, Ferrara LC, Briggs BA, et al:  Survival, hospitalization charges and follow-up results in critically ill patients . N Engl J Med 1976;;294:982-987.
3 +
Turnbull AD, Carlon G, Baron R, et al:  The inverse relationship between cost and survival in the critically ill cancer patient . Crit Care Med 1979;;7:20-23.
4 +
Russell LB: Technology in Hospitals . Washington, DC, The Brookings Institution, 1979;.
5 +
Hospital Statistics: 1979 Edition . Chicago, American Hospital Association, 1979;.
6 +
Thibault GS, Mulley AG, Barnett GO, et al:  Medical intensive care: Indications, interventions, and outcomes . N Engl J Med 1980;;302:938-942.
7 +
Cullen DJ, Civetta JM, Briggs BA, et al:  Therapeutic intervention scoring system: A method for quantitative comparison of patient care . Crit Care Med 1974;;2:57-60.
8 +
Byrick RJ, Mindorff D, McKee L, et al:  Cost-effectiveness of intensive care for respiratory failure patients . Crit Care Med 1980;;8:332-337.
9 +
Cullen DJ:  Results and costs of intensive care . Anesthesiology 1977;;47:203-216.
10 +
Knaus WA, Zimmerman JE, Wagner DP, et al:  APACHE—acute physiology and chronic health evaluation: A physiologically based classification system . Crit Care Med 1981;;9:591-597.
11 +
Knaus WA, Thibault GE:  Intensive care units today , in McNeil BJ, Cravalho EG (eds): Critical Issues in Medical Technology . Boston, Auburn Press, to be published.
12 +
Knaus WA, Draper E, Lawrence DE, et al:  Neurosurgical admissions to the intensive care unit: Intensive monitoring versus intensive therapy . Neurosurgery 1981;;8:438-441.
13 +
Knaus WA, Wagner DP, Zimmerman JE:  A national comparison of ICU admissions , abstracted. Clin Res 1981;;29:321.
14 +
Draper EA, Wagner DP, Knaus WA:  The use of intensive care: A comparison of a university and community hospital . Health Care Financing Rev , to be published.

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