Adult intensive care in an environment of resource restriction: How should the unit director respond?

Adult intensive care touches the lives of very few while consuming a disproportionatelyhigh level of resources. To survive in the future environment of resource restrictionand accountability, the unit director must rapidly acquire a wide range of professionalmanagement skills. The intensive care unit director must be able to demonstrate tocolleagues, health managers and the community that the large amount of resourcesprovided to intensive care, and the remarkable freedom given to intensivists to usethose resources, are justified in terms of compassionate evidenced-based care, efficiency,efficacy and appropriateness. While many outcomes may be subjected to audit,intensive care units must publish minimal performance data indexed to severity ofillness and including their mortality, hospital mortality and length of stay and anoverall indicator of patient acuity to identify patients at low risk who need not beadmitted to an expensive intensive care bed.