Organisation and Management of Intensive Care

1. Front Matter

   Pages I-XX

   PDF

2. Part I

   1. Front Matter

      Pages 1-1

      PDF

   2. EURICUS-I: Introduction

      • Dinis Reis Miranda, David W. Ryan, Wilmar B. Schaufeli, Václav Fidler

      Pages 3-4

   3. Study Design

      • Dinis Reis Miranda, David W. Ryan, Wilmar B. Schaufeli, Václav Fidler

      Pages 5-12

   4. Study Results

      • Dinis Reis Miranda, David W. Ryan, Wilmar B. Schaufeli, Václav Fidler

      Pages 13-37

   5. Integration of Substudies

      • Dinis Reis Miranda, David W. Ryan, Wilmar B. Schaufeli, Václav Fidler

      Pages 38-49

   6. Conclusions

      • Dinis Reis Miranda, David W. Ryan, Wilmar B. Schaufeli, Václav Fidler

      Pages 50-54

   7. Recommendations

      • Dinis Reis Miranda, David W. Ryan, Wilmar B. Schaufeli, Václav Fidler

      Pages 55-58

3. Part II

   1. Front Matter

      Pages 59-59

      PDF

   2. Field Work

      • Dinis Reis Miranda, David W. Ryan, Wilmar B. Schaufeli, Václav Fidler

      Pages 61-113

   3. Substudies

      • D. Reis Miranda, J. van der Veen, R. Moreno, W. van Rossum, W. Schaufeli, P. Le Blanc et al.

      Pages 114-238

   4. Highlights of the EURICUS-I Data

      • R. Moreno, A. van Dort, K. Rowan, G. Apolone, Václav Fidler

      Pages 239-269

4. Back Matter

   Pages 271-287

   PDF

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.

• care
• health care economics
• health services research
• human resources
• intensive care
• intensive care unit
• non-profit organization

• Health Services Research Unit, University Hospital Groningen, Groningen, The Netherlands

  Dinis Reis Miranda

• ICU, Freeman Hospital, Newcastle upon Tyne, UK

  David W. Ryan

• Department of Social and Organisational Psychology, University of Utrecht, Utrecht, The Netherlands

  Wilmar B. Schaufeli

• Faculty of Medicine, University of Groningen, Groningen, The Netherlands

  Václav Fidler

Policies and ethics