Performance of adult intensive care units. Thirty years' experience

ICU performance can be evaluated by using the standard mortality ratio (SMR), but the points of view of the patients, families, and medical and non medical staff must also be taken in account. The SMR is the ratio between the observed (0) and predicted hospital mortality rates (P), based on a statistical model. If for 100 consecutive unselected patients the O/P ratio is less than 11 then the performance is considered good, and otherwise as bad. Most studies show goodpost-ICU quality of life. Management of dying patients in the ICU is all important issue. Families are stressed, both during and after the ICU stay, and they often have signs of anxiety and depression. It is illogical to involve them in hard decisions such as halting active therapy. Medical and non medical staff are also under pressure and may suffer from the burn-out syndrome. Causes include conflicts among doctors, or between doctors and nurses. There is a close relationship between ICU organisation and performance: good management makes for high performance.