The role of an intensive care unit in a community hospital. A ten-year review with observations on utilization past, present, and future.

A retrospective ten-year review of the surgical-intensive-care-unit utilization practices at Riverside Community Hospital revealed that, according to the author's criteria, an average of 32% of over 800 yearly admissions could have been safely managed in a less intensive and expensive environment. The admission practices, monitoring parameters, length of stay, and intensity of nursing interaction were evaluated and compared with those of published reports. Prospective payment by diagnosis-related groups will likely force a change in the existing use of surgical intensive care units. Surgeons are urged to examine the utilization of their hospitals' intensive care units and actively work with their hospital administration to establish intermediate care units so that patients will not be jeopardized by the impending fiscal constraints of diagnosis-related groups.