Mallick R, Strosberg M, Lambrinos J, Groeger J S
Graduate Management Institute, Union College, Schenectady, NY 12308, USA.
Med Care. 1995 Jun;33(6):611-24. doi: 10.1097/00005650-199506000-00004.
This article examines the impact of greater management involvement by the medical director on efficiency of bed allocation in the intensive care unit (ICU) or critical care unit. Managerial involvement is modeled using a principal components approach in terms of perceived supervision, conflict resolution regarding bed allocation at critical times, extent of control over treatment, and employment status. Using data from a 1991 survey of 2,879 ICUs in 1,706 hospitals conducted by the Society of Critical Care Medicine, two equations reflecting efficiency--the ICU occupancy rate and the presence of misallocated ICU patients--were estimated. It was found that greater involvement by medical directors in the day-to-day management of the ICU significantly reduces the average occupancy rate in ICUs and also the probability of patients misallocated to the ICU, suggesting superior resource allocation in ICUs as a result. These results also suggest that the managerial impact of the medical director is greater in ICUs in high-occupancy hospitals.
本文探讨了医疗主任更多地参与管理对重症监护病房（ICU）或危重症监护病房床位分配效率的影响。管理参与度通过主成分分析法进行建模，涉及感知监督、关键时期床位分配的冲突解决、治疗控制程度和就业状况。利用危重症医学会1991年对1706家医院的2879个ICU进行调查的数据，估计了反映效率的两个方程——ICU占用率和ICU患者分配错误的情况。研究发现，医疗主任更多地参与ICU的日常管理可显著降低ICU的平均占用率，以及患者被错误分配到ICU的概率，这表明ICU的资源分配更优。这些结果还表明，在高占用率医院的ICU中，医疗主任的管理影响更大。
