Rationing Intensive Care--Physician Responses to a Resource Shortage
Singer, Daniel E.
Carr, Phyllis L.
Mulley, Albert G.
Thibault, George E.
New England Journal of Medicine. 1983 Nov 10; 309(19): 1155-1160.
A shortage of intensive care unit (ICU) nurses at Massachusetts General Hospital and the subsequent reduction of bed capacity provided an opportunity to study physicians' behavior in rationing ICU use. They responded by restricting admissions to acutely ill patients and reducing the ICU's monitoring function, apparently with little or no adverse consequences. There seemed to be no withdrawal of care from dying patients. These results suggest that moderate resource limitation can encourage more efficient use of intensive care. However, the authors caution against reducing ICU use without assessment and allocation guidelines. (KIE abstract)
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