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Managing the Critical Care Unit
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Pollack MM, Cuerdon TT, Patel KM, Ruttimann UE, Getson PR, Levetown M: Impact of quality-of-care factors on pediatric intensive care unit mortality. JAMA 1994, 272:941-946. A multicenter trial that evaluates the impact of the presence of pediatric intensivists on resources and patient outcome. This methodology is excellent and the conclusions have important implications that extend beyond the realm of pediatric critical care.
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Mallick R, Strosberg M, Lanbrinos, Groeger JS: The intensive care unit medical director as manager: impact on performance. Med Care 1995, 33:611-624. A study that is based on a large survey of ICU medical directors.
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Smithies MN, Bihari D, Chang R: Scoring systems and the measurement of ICU cost effectiveness. Reanin Med Urgence 1994, 3:215-221. Provides a method to link cost-effectiveness to patient acuity. The methods are superb, well presented, and can (and should) be easily applied to other ICUs.
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Rapoport J, Teres D, Lemeshow S, Gehlbach S: A method for assessing the clinical performance and cost-effectiveness of intensive care units: a multicenter inception cohort study. Crit Care Med 1994, 22:1385-1391. The findings from a large, international, multi-ICU study, which provides a practical link between predicted outcome and ICU cost. The reader should pay close attention to the method used to assess ICU resource use.
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Wachter RM, Luce JM, Safrin S, Berrios DC, Charlebois E, Scitovsky AA: Cost and outcome of intensive care for patients with AIDS, Pneumocystis carinii pneumonia, and severe respiratory failure. JAMA 1995, 273:230-235. An excellent study that, aside from the implications for the critical care of the patient with human immunodeficiency virus, describes methods that can be applied to other settings and problems.
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