Management of Intensive Care

I: Introduction.- 1. Intensive Care Medicine.- 1.1 Fundamentals of Intensive Care Medicine.- 1.2 The facilities.- 1.3 The different interpretations of Intensive Care Medicine.- 1.4 ICM to whom?.- 1.5 Ethics.- 2. Guidelines for Intensive Care Medicine.- 2.1 Why guidelines?.- 2.2 The target-groups.- 2.3 The guidelines.- II: The Patients.- 1. Introduction.- 2. Measuring the type of patients.- 2.1 Referral source.- 2.2 The problem of diagnosis.- 3. Measuring the previous health status and the severity of illness.- 3.1 Previous Health Status.- 3.2 Severity Indexes.- 4. Measuring the workload.- 4.1 The TISS system.- 4.2 The Omega system.- 4.3 The PRN system.- 5. Measuring the evolution of severity of illness.- 5.1 The OSF system.- 5.2 The Sickness Scoring (SS).- 6. Stratification of patient related data.- 6.1 Essential data.- 6.2 Important data.- 6.3 Desirable data.- 6.4 Optional data.- References.- Tables.- III: The Facilities.- 1. Introduction.- 2. ICUs in Europe: The great diversity.- 2.1 Size.- 2.2 Utilization pattern.- 2.3 Education and training.- 2.4 Classification of ICUs.- 3. The type and size of Intensive Care facilities.- 3.1 The type of ICUs.- 3.2 The size of ICUs.- 3.3 The location of ICUs.- 4. General standard for ICUs.- 4.1 Space and technical conditions.- 4.2 Attendance protocols and procedure manuals.- 4.3 Ancillary services.- 4.4 Quality assurance.- 5. Staffing.- 6. Comparing facilities.- Addendum I.- Addendum II.- Addendum III.- Addendum IV.- References.- IV: National and Regional Organisation.- 1. Introduction.- 2. Estimating the total number of ICU beds required.- 2.1 Rates of occupancy and availability.- 3. Factors influencing regional planning.- 3.1 Hierarchy of IC facilities.- 4. Levels of care.- 4.1 Determinants of levels of care.- 5. Calculating manpower needs.- 6. Conclusions.- References.- V: Management Control in the ICU.- 1. Planning and control.- 2. The ICU: Expense or responsibility centre?.- 3. Performance criteria.- 4. Incentives and constraints of ICU performance.- 4.1 Patient characteristics.- 4.2 Admissions and discharge decisions.- 4.3 ICU inputs.- 4.4 ICU throughputs.- 4.5 Final ICU outputs.- 5. Conclusions.- References.- VI: Education and Training.- 1. Introduction.- 2. The actual education and training of Intensive Care Medicine.- 2.1 Physicians.- 2.2 Nurses.- 2.3 Other personnel.- 3. General recommendations.- 3.1 Physicians.- 3.2 Nurses.- 3.3 Other personnel.- 4. Conclusions.- Addendum I. Present situation in European countries.- Addendum II. Basic education.- Addendum III. Special education.- Addendum IV. Catalogue of skills for special Intensive Care Medicine training.- Addendum V. General Intensive Care nursing for registered general nurses.- Addendum VI. Special Intensive Care training for nurses in West-Germany.- VII: Evaluation in Intensive Care.- 1. What should or could be evaluated.- 1.1 Technologies and interventions.- 1.2 Organisational studies.- 2. Who should evaluate?.- 2.1 Internal audit.- 2.2 External audit.- 2.3 Concensus conference.- 2.4 Recommendations.- 3 Intensivists should try to adopt common definitions and classifications.- 3.1 Classification of patients in large series.- 3.2 Classification of patients by specific diagnoses.- 3.3 DRGs and evaluation.- 4. Evaluation studies must have a proper scientific design.- 4.1 Study design.- 4.2 Proper control group.- 4.3 Stratification.- 5. The proper judgement criteria must be employed.- 6. Long term evaluation of Intensive Care: Health status and quality of life.- 6.1 Definitions.- 6.2 Proper scale.- 6.3 General characteristics of the scales.- 6.4 Functional status scales.- 6.5 Generic measures of health status.- 6.6 Measurements of perceived quality of life.- 6.7 Recommendations.- 7. Economic evaluation of intensive care utilisation.- 7.1 Cost-Benefit Analysis (CBA).- 7.2 Cost-Effectiveness Analysis (CEA).- 7.3 Conclusions and general recommendations.- References.- Table 1. Data for Evaluation of ICM.- Table 2. Components of the Activity of Daily Living.- Table 3. Elements of the Sickness Impact Profile.- Table 4. Components of the Quality of Well Being.- Table 5. Components of the Perceived Quality of Life Index.- Table 6. Costs and Benefits of Intensive Care.- Table 7. Cost Accounting in the ICU.- VIII: Epilogue.- 1. Introduction.- 2. Quantification.- 3. Regionalisation.- 4. Professionalisation.- 5. Levels of responsibility.- 6. Intensive Care Medicine societies.- 7. Concluding comments.- Directory of Intensive Care Organisations.- Subject Index and Abbreviations.- Nigel Turner.