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An Alternative to Rationing

Cory M. Franklin, MD; Eric C. Rackow, MD; Bashir Mamdani, MD; Steven Nightingale, MD; Gerald Burke, MD; Max H. Weil, MD, PhD

Arch Intern Med. 1988;148(6):1403-1405.

Abstract
• The admission and case fatality rate (CFR) on a large urban medical service for 12 months before and after the creation of an intermediate care unit were examined. In the year after the intermediate care unit was opened, total admissions to the ICU/CCU decreased by 7.1% as a result of a 14.6% decrease in admission of low-risk patients who did not require critical care services. The CFR of patients on the medical service decreased by 13.3% in the year after implementation of the intermediate care unit. The decrease in mortality was accounted for by a 25.0% decrease in general ward deaths and a 38.8% decrease in ward cardiac arrests. There was no significant difference in the ICU/CCU CFR. The admission of low-risk patients to an intermediate care unit provided greater access to intensive care and was associated with an overall lower medical service CFR.

(Arch intern Med 1988;148:1403-1405)

Author Affiliations
From the Division of Critical Care Medicine, Department of Medicine, University of Health Sciences/The Chicago Medical School, North Chicago, Ill (Drs Rackow and Weil), and Division of Critical Care Medicine, Department of Medicine, Cook County Hospital, Chicago (Drs Franklin, Mamdani, Nightingale, and Burke).

Footnotes
Accepted for publication Dec 12, 1987.

Reprint requests to Department of Medicine, University of Health Sciences/The Chicago Medical School, 3333 Green Bay Rd, North Chicago, IL 60064 (Dr Rackow).

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