Allocation of Intensive Care Resources

Since its inception some three decades ago the concept of intensive care underwent considerable changes: Firstly, the ICU has become a distinct hospital ward specifically built to allow the use of ultramodern technology and the execution of exhaustive protocols (infection control etc). Secondly, the patients admitted for therapy have evolved away from those suffering from the acute respiratory failure of neuromuscular insufficiency to encompass all clinical conditions representing a threat to life. Admission criteria have also changed and now include patients with poor or even no prognosis; the availability of an empty ICU bed often prompts the admission of a patient not requiring intensive care at all. Thirdly, costs have escalated enormously, second only to the operating suite as the most expensive clinical facility of the modern hospital. It is now estimated that as much as 20% of hospital resources are expended in the provision of ICU facilities for only 5% of total hospital admissions. Moreover, with an average rate of ICU mortality far exceeding 20%, a substantial sum of money is being invested to produce just one survivor.