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This paper provides much needed evidence that investment into
Critical Care Services in England improved mortality at a very competitive
price. Critical Care beds are good for you!!
What is not clear is by what mechanism the extra investment
contributed to improved results.
Several explanations are possible some of which might be answered
from existing data of the Intensive Care National Audit and Research
1. Treatments just got better as in many other specialties, the
investment did not contribute to the changes.
2. The extra investment did improve outcomes in England: Critical
Care Services in Wales, which also collects some data into the Case Mix
Program, did not expand critical care beds in the same way as England.
Would this be reflected in worse outcomes for Welsh patients in the same
3. The increased number of admissions allowed more units to achieve a
critical volume in the management of emergencies (as opposed to routine
postoperative patients) in order to catch up with mortality rates achieved
by units in North America and Western Europe ?
Wunsch H, Angus DC, Harrison DA et al. Variation in critical care
services across North America and Western Europe. Crit Care Med