Utilization Strategies for Intensive Care Units
Kalb, Paul E.
Miller, David H.
JAMA. 1989 Apr 28; 261(16): 2389-2395.
Considerable evidence supports the contention that U.S. hospitals ration critical care resources in an informal, often irrational and unfair manner. The value, efficacy, and cost of intensive care units are discussed and two options are proposed to tackle the problem of rationing. Hospitals should either establish formal, specific, and equitable rationing guidelines or, alternatively, develop plans to avoid rationing by increasing the supply of resources or by decreasing the demand for them. It is suggested that demand be decreased by more aggressive discharge or by a system of graded care rather than by denying admission. Arguments in favor of and against rationing are presented. It is concluded that, whichever option is chosen, plans should be developed openly, approved by appropriate supervisory bodies, and brought to the attention of hospital staff and patients. (KIE abstract)
Advance Directives; Allowing to Die; Alternatives; Biomedical Technologies; Critically Ill; Cultural Pluralism; Decision Making; Evaluation; Guidelines; Hospitals; Institutional Policies; Intensive Care Units; Justice; Life; Mortality; Patient Admission; Patient Discharge; Patient Participation; Patients; Physicians; Prognosis; Quality of Life; Resource Allocation; Scarcity; Selection for Treatment; Social worth; Statistics; Utilitarianism; Values; Withholding Treatment;
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