Medical Intensive Care in the Teaching Hospital: Costs Versus Benefits

In the teaching hospital, improved patient care, education, and research are anticipated outcomes of intensive care units. Finite resources dictate the examination of these benefits in relation to costs. Costs include not only the direct and indirect (overhead) expenses of an intensive care unit but also of ancillary services, such as laboratory tests. Studies of the effectiveness of intensive care have been limited mainly to comparison of mortality among patients with myocardial infarction receiving treatment in intensive versus conventional care settings. Studies of outcome of intensive care for other well-defined illnesses are in order that include other indexes, such as complications and functional status and mortality over an extended period after hospital discharge. The benefits of research and education in the intensive care setting should be evaluated. Only marginal improvement in the outcome of intensive care for selected conditions may still justify it if significant gains in education or research gains can be shown.