Miranda D R, Gimbrère J
Department of Surgery, University Hospital of Groningen, The Netherlands.
New Horiz. 1994 Aug;2(3):357-63.
In The Netherlands, 8.3% of the gross national product is allocated to health care. Medical care provided in ICUs consumes approximately 8% of hospital budgets, or approximately 2.5% of the total healthcare budget. The high cost of intensive care medicine in The Netherlands has become a matter of concern during the last decade. A national intensive care study was conducted from 1989 through 1990 to evaluate the effectiveness and organization of ICUs in the country. This study has shown that there is an association between the operational characteristics of ICUs and the hospital in which these units operate. In approximately 50% of ICUs studied, a marked mismatch existed between the provision and the use of resources. Surgical activities in the hospital were the major observed cause for this mismatch, mainly because ICUs were often used instead of the recovery room, which operated only about 8 to 10 hrs/day during working days. In addition to an absence of clearly written policies for the use of the facilities, a lack of sound ICU business organization and management was also documented and may have contributed to the observed misuse of resources and the dissatisfaction and burnout of hospital personnel. In order to improve the use of resources and to establish a controllable program of cost containment in ICUs in The Netherlands, the recommendations made to Dutch authorities were aggregated under two headings: a) the adoption of a quantifiable method for defining levels of ICU care; and b) the enforcement of the professional organization and management of ICUs.
在荷兰，国民生产总值的8.3%用于医疗保健。重症监护病房（ICU）提供的医疗服务消耗了医院预算的约8%，约占医疗保健总预算的2.5%。在过去十年中，荷兰重症监护医学的高成本已成为一个令人担忧的问题。1989年至1990年进行了一项全国性的重症监护研究，以评估该国ICU的有效性和组织情况。这项研究表明，ICU的运营特征与这些科室所在的医院之间存在关联。在所研究的约50%的ICU中，资源的供应与使用之间存在明显不匹配。医院的外科手术活动是观察到的造成这种不匹配的主要原因，主要是因为ICU经常被使用，而不是恢复室，恢复室在工作日每天仅运行约8至10小时。除了缺乏关于设施使用的明确书面政策外，还记录了ICU缺乏健全的业务组织和管理情况，这可能导致了所观察到的资源滥用以及医院工作人员的不满和倦怠。为了提高资源利用效率并在荷兰的ICU中建立可控的成本控制计划，向荷兰当局提出的建议归纳为两个标题：a）采用一种可量化的方法来定义ICU护理水平；b）加强ICU的专业组织和管理。
