From the viewpoint of a health economist, the intensive care unit (leU) is a particularly fascinating phenomenon. It is the epitome of "high-tech" medicine and frequently portrayed as the place where life-saving miracles are routinely wrought. But the popular imagina­ tion is also caught up in the darker side, when agonizing decisions have to be made to avoid futile and inhuman continuation of expen­ sive treatments. My analytical interests led me to approach these issues by asking what the evidence tells us about which leu activities are very bene­ ficial in relationship to their costs and which are not. This quickly translates into a slightly different question, namely, which patients are most appropriately treated in an leu and which not. Unfor­ tunately, it is very hard to answer these questions because it has pro­ ved very difficult to investigate these issues in the manner which is now regarded as the "gold standard:' namely by conducting rando­ mized clinical trials or alternative courses of action. I think this is a pity, and I am not at all convinced that it would be unethical to do so in many cases, because there is wide variation in practice and ge­ nuine doubt as to which practices are best -the two conditions that need to be fulfilled before such a trial is justifiable.

Inhalt

EURICUS-I: Introduction.- 1 Study Design.- Background.- The EURICUS Master-Project.- The EURICUS-I Project.- Objectives.- Methodology.- Project Management.- Selection of ICUs.- 2 Study Results.- Patients.- Case-mix.- Outcome.- Organisation and Management Data Results.- Field Work.- Notes on Intensive Care Medicine Systems in Europe.- Substudy Patients and Facilities.- ICU Performance.- Use of the Facilities.- Substudy Organisation.- Substudy Personnel.- Substudy Culture.- Substudy Finances.- Special Subjects.- Levels of Care.- High Turnover of Patients in the ICU.- The Recovery Room.- The ICU Profile of Hospital Categories.- 3 Integration of Substudies.- Hypothesis Testing.- The Independent Variables.- Substudy Patients and Facilities.- Substudy Organization.- Substudy Personnel.- Substudy Culture.- Substudy Finances.- Results.- Explorative Integration of Substudies.- Nonclinical Performance.- Integration of Results of Substudies in the Light of the Field Work Survey.- 4 Conclusions.- Organization and Planning.- Organization and Performance of ICUs.- Use of Resources.- 5 Recommendations.- 6 Field Work.- Site Visits.- Expectations of the Study.- The Nurses.- The Visiting System.- The ICU as an Organization.- Conclusions.- Notes on Intensive Care Medicine Systems in Europe.- Intensive Care Medicine in Poland.- Intensive Care Medicine in Germany.- Intensive Care Medicine in Denmark.- Intensive Care Medicine in Finland.- Intensive Care Medicine in The Netherlands.- Intensive Care Medicine in Belgium.- Intensive Care Medicine in France (With Special Attention to Medical ICUs).- Intensive Care Medicine in Luxembourg.- Intensive Care Medicine in the United Kingdom.- Intensive Care Medicine in Italy.- Intensive Care Medicine in Spain.- Intensive Care Medicine in Portugal.- Comments.- 7 Substudies.- Patients and Facilities.- The Hospitals.- The Intensive Care Units.- The Patients.- Use of the Facilities.- Conclusions.- Organization.- The Organisational Variability of ICUs.- The Variables.- The Dependent Variable: Medical Performance of ICUs.- The Multiple Regression Analyses: Testing the Hypotheses.- Conclusions.- Personnel.- Method.- Results: Job Analysis (WEBIC Questionnaire).- Results: Work and Well-Being Questionnaire.- Results: The Basic and Extended Research Models.- Conclusions.- Cultures in ICUs.- Definition of Organizational Culture.- Measuring Organizational Cultures.- The Design of the Comparative Study of the Intensive Care Units.- Results.- Conclusion and Implications.- Summary.- Finances.- Data.- The Cost Structure of European ICUs.- Budgeting Procedure.- Cost Accounting in ICUs.- Conclusion.- 8 Highlights on the EURICUS-I Data.- Data-Handling and Analysis.- Random Data-Entry Checks.- Assessment of Severity of Illness Scoring Systems.- Splitting of the Database.- Assessment of Original SAPS II and MPM0 Performance on EURICUS-I Database.- Conclusions.- Analysis of ICU Performance.- ICU Performance.- Method of Hypothesis Testing.- Results.- Conclusions.- III.- Participants in EURICUS-I.