Intermediate Care

In an era of cost containment, critical care units have come under increasing scrutiny. The cost of caring for critically ill patients—many of whom do not survive—is high. A few years ago, the debate centered around whether critical care unit resources should be utilized for patients who were unlikely to survive.¹,²Most of the issues remain unresolved, and are, perhaps, unresolvable. More recently, a number of studies have suggested that efforts to improve utilization of critical care units should concentrate on limiting the admission of low-risk patients.³⁻⁵Such patients, often with cardiac problems, are usually admitted to units for monitoring. Costs are high, and the potential for benefit is low, given the very low risk of morbidity or mortality. Moreover, such patients may tie up a limited resource, preventing admission of unstable patients who may benefit.⁶One potential solution is the development of intermediate See p 1403.