Introduction

The intensive care unit (ICU) is a concentration of specific professional expertise and high-technology equipment around a number of beds located in a sophisticated hospital environment. The wealth of the unit, or its richness measured as education and number of personnel, type and quantity of equipment, the use of more expensive medication, etc., may vary widely among ICUs and is largely dependent on the local institutional context of health care organization and financing.

The principal objective of the ICU is to provide monitoring and therapeutic facilities for critically ill patients which cannot be supplied elsewhere in the hospital. Therefore other hospital departments often request the ICU to contribute to the treatment of critically ill patients. Depending upon its professional characteristics and wealth, the ICU may also be requested to contribute to the care of patients in another hospital. In this case, the ICU may assume a kind of central function which was quite probably not considered in its original objectives.

As the activities performed in the ICU can be seen as temporary interventions integrated with the longitudinal process of care in other hospital departments, the ICU is frequently classified in the group of 'cost centers' in the hospital, together with the operating theater, the laboratories, etc. In general, in addition to professional expertise, a cost center is allocated resources for performing activities that are requested 'externally'.

However, because of the large financial impact of ICU activities on the hospital budget, many hospital administrations are beginning to enforce 'resource management' in the ICU. As it becomes clear that effective management of resources requires active contribution from the professionals using the resources, the involvement of ICU physicians and nurses in resource management activities is increasing substantially. This implies that, in addition to their specific professional responsibilities, physicians and nurses in the ICU take responsibility for the whole process of resource consumption in the ICU, from admission to discharge of each patient. Therefore the ICU is becoming a 'responsibility center', negotiating its annual budget for delivery of agreed outputs (number and type of patients, quality of care, etc.) with the hospital administration.

It should be emphasized that the problem does not end here, as prediction of the activities to be developed is the first relevant factor of effective management. The need for prediction for sound resource management requires consideration of health care strategies defined at other levels of decision-making.

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