Main description:

From the viewpoint of a health economist, the intensive care unit (leU) is a particularly fascinating phenomenon. It is the epitome of "high-tech" medicine and frequently portrayed as the place where life-saving miracles are routinely wrought. But the popular imagina tion is also caught up in the darker side, when agonizing decisions have to be made to avoid futile and inhuman continuation of expen sive treatments. My analytical interests led me to approach these issues by asking what the evidence tells us about which leu activities are very bene ficial in relationship to their costs and which are not. This quickly translates into a slightly different question, namely, which patients are most appropriately treated in an leu and which not. Unfor tunately, it is very hard to answer these questions because it has pro ved very difficult to investigate these issues in the manner which is now regarded as the "gold standard:' namely by conducting rando mized clinical trials or alternative courses of action. I think this is a pity, and I am not at all convinced that it would be unethical to do so in many cases, because there is wide variation in practice and ge nuine doubt as to which practices are best -the two conditions that need to be fulfilled before such a trial is justifiable.

Contents:

EURICUS-I: Introduction.- 1 Study Design.- Background.- The EURICUS Master-Project.- The EURICUS-I Project.- Objectives.- Methodology.- Project Management.- Selection of ICUs.- 2 Study Results.- Patients.- Case-mix.- Outcome.- Organisation and Management Data Results.- Field Work.- Notes on Intensive Care Medicine Systems in Europe.- Substudy Patients and Facilities.- ICU Performance.- Use of the Facilities.- Substudy Organisation.- Substudy Personnel.- Substudy Culture.- Substudy Finances.- Special Subjects.- Levels of Care.- High Turnover of Patients in the ICU.- The Recovery Room.- The ICU Profile of Hospital Categories.- 3 Integration of Substudies.- Hypothesis Testing.- The Independent Variables.- Substudy Patients and Facilities.- Substudy Organization.- Substudy Personnel.- Substudy Culture.- Substudy Finances.- Results.- Explorative Integration of Substudies.- Nonclinical Performance.- Integration of Results of Substudies in the Light of the Field Work Survey.- 4 Conclusions.- Organization and Planning.- Organization and Performance of ICUs.- Use of Resources.- 5 Recommendations.- 6 Field Work.- Site Visits.- Expectations of the Study.- The Nurses.- The Visiting System.- The ICU as an Organization.- Conclusions.- Notes on Intensive Care Medicine Systems in Europe.- Intensive Care Medicine in Poland.- Intensive Care Medicine in Germany.- Intensive Care Medicine in Denmark.- Intensive Care Medicine in Finland.- Intensive Care Medicine in The Netherlands.- Intensive Care Medicine in Belgium.- Intensive Care Medicine in France (With Special Attention to Medical ICUs).- Intensive Care Medicine in Luxembourg.- Intensive Care Medicine in the United Kingdom.- Intensive Care Medicine in Italy.- Intensive Care Medicine in Spain.- Intensive Care Medicine in Portugal.- Comments.- 7 Substudies.- Patients and Facilities.- The Hospitals.- The Intensive Care Units.- The Patients.- Use of the Facilities.- Conclusions.- Organization.- The Organisational Variability of ICUs.- The Variables.- The Dependent Variable: Medical Performance of ICUs.- The Multiple Regression Analyses: Testing the Hypotheses.- Conclusions.- Personnel.- Method.- Results: Job Analysis (WEBIC Questionnaire).- Results: Work and Well-Being Questionnaire.- Results: The Basic and Extended Research Models.- Conclusions.- Cultures in ICUs.- Definition of Organizational Culture.- Measuring Organizational Cultures.- The Design of the Comparative Study of the Intensive Care Units.- Results.- Conclusion and Implications.- Summary.- Finances.- Data.- The Cost Structure of European ICUs.- Budgeting Procedure.- Cost Accounting in ICUs.- Conclusion.- 8 Highlights on the EURICUS-I Data.- Data-Handling and Analysis.- Random Data-Entry Checks.- Assessment of Severity of Illness Scoring Systems.- Splitting of the Database.- Assessment of Original SAPS II and MPM0 Performance on EURICUS-I Database.- Conclusions.- Analysis of ICU Performance.- ICU Performance.- Method of Hypothesis Testing.- Results.- Conclusions.- III.- Participants in EURICUS-I.