Safety, effectiveness and costs of different models of organising care for critically ill patients: literature review.

New ways of working in critical care are emerging in response to increasing demands for care in the context of a limited critical care workforce. This review appraised the comparative safety, effectiveness and costs of new ways of working in critical care. All papers published in peer reviewed journals during 1990-2003 were utilised. A total of 933 potentially relevant papers were identified. Secondary sources including policy papers, and experts within the field were also used to inform this work. Initially 113 papers met the inclusion criteria. However, 58 of these described policy and secular trends in critical care and were therefore used only to provide background information. A total of 55 papers were then critically reviewed to provide academic focus on the subject area. Examples of comparative empirical research on new ways of working were limited, but the review revealed research activity in the areas of: impact of workload; nursing, medical and organisational factors affecting patient outcomes; and methods to support workforce calculations. The findings suggest that research into longer-term patient outcomes is needed together with a proactive and strategic interdisciplinary approach to practice, policy and research.