Medical intensive care in a community teaching hospital.

The success of efforts at cost containment in medical intensive care units of community hospitals will ultimately depend on accurate assessments of their use by practitioners. This study analyzes 167 consecutive admissions to such a facility, 81 percent of which were supervised by physicians in practice in the community. The results suggest that a significant number of patients are admitted only for observation or conventional medical care, that a substantial proportion of resources is spent on the care of patients who die immediately and that there are few practitioners with enough experience in the daily operation of this facility to develop broad perspectives of its use. Physicians with specific training or more experience in intensive care medicine, such as full-time directors of medical intensive care units, should participate in the decisions about the allocation of the limited resources available to the critically III.