Connect
MJA
MJA

The evolving role of intensive care in health care and society

Stephen Warrillow and Raymond Raper
Med J Aust 2019; 211 (7): . || doi: 10.5694/mja2.50340
Published online: 7 October 2019
Correction(s) for this article: Erratum | Published online: 6 October 2024

Despite the evolving needs of patients and changing societal expectations, Australasian intensive care continues to provide a world leading service to patients and the broader society

With Melbourne hosting the 2019 World Congress of Intensive Care, it is timely to reflect on the nature of the speciality and consider its role within health care. The intensive care unit (ICU) can be a daunting place. For patients, families and even non‐intensive care clinicians, the complex and technically advanced environment can feel intimidating. The ICU represents a microcosm of the broader acute health care system, where the challenges of patient‐centred care, treatment, communication and resource management are encountered in a more impactful setting. The reach of intensive care is wide; current estimates from the Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation suggest that Australians and New Zealanders have a 50% lifetime chance of requiring admission to an ICU.1 Intensive care interacts with every other element of acute care, serving the needs of patients, specialist units, hospitals and broader society. In its more recent history, intensive care has evolved to encompass more than just a single geographic location; it is an organised system of care that ensures delivery of timely and expert treatment to critically ill patients, increasingly extending this capability beyond the walls of the ICU itself and into many other settings.


  • 1 Austin Heath, Melbourne, VIC
  • 2 Australian and New Zealand Intensive Care Society, Melbourne, VIC
  • 3 University of Melbourne, Melbourne, VIC
  • 4 College of Intensive Care Medicine of Australia and New Zealand, Melbourne, VIC
  • 5 Royal North Shore Hospital, Sydney, NSW



Competing interests:

Stephen Warrilow is President of the Australian and New Zealand Intensive Care Society and Convenor of the 2019 World Congress of Intensive Care. Raymond Raper is President of the CICM.

  • 1. Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation. Adult patient database. https://www.anzics.com.au/adult-patient-database-apd/ (viewed July 2019).
  • 2. Lichtenberg FR. The impact of biomedical innovation on longevity and health. Nordic J Health Econ 2015; 5: 45–57.
  • 3. Montgomery H, Grocott M, Mythen M. Critical care at the end of life: balancing technology with compassion and agreeing when to stop. Br J Anaesth 2017; 119 Suppl 1: i85–i89.
  • 4. Bagshaw SM, Webb SAR, Delaney A, et al. Very old patients admitted to intensive care in Australia and New Zealand: a multi‐centre cohort analysis. Crit Care 2009; 13: R45.
  • 5. Muscedere J, Waters B, Varambally A, et al. The impact of frailty on intensive care unit outcomes: a systematic review and meta‐analysis. Intensive Care Med 2017; 43: 1105–1122.
  • 6. Darvall JN, Bellomo R, Paul E, et al. Frailty in very old critically ill patients in Australia and New Zealand: a population‐based cohort study. Med J Aust 2019; 211: 318–323.
  • 7. Corke C, Leeuw E, Lo SK, George C. Predicting future intensive care demand in Australia. Crit Care Resusc. 2009; 11: 257–260.
  • 8. Melville A, Kolt G, Anderson D, et al. Admission to intensive care for palliative care or potential organ donation: demographics, circumstances, outcomes, and resource use. Crit Care Med 2017; 45: e1050–e1059.
  • 9. Hicks P, Huckson S, Fenny E, et al. The financial cost of intensive care in Australia: a multicentre registry study. Med J Aust 2019; 211: 324–325.
  • 10. Prin M, Wunsch H. International comparisons of intensive care: informing outcomes and improving standards. Curr Opin Crit Care 2012; 18: 700–706.
  • 11. Hillman KM, Chen J, Jones D. Rapid response systems. Med J Aust 2014; 201: 519–521. https://www.mja.com.au/journal/2014/201/9/rapid-response-systems
  • 12. Lasiter S, Oles SK, Mundell J, et al. Critical care follow‐up clinics: a scoping review of interventions and outcomes. Clin Nurse Spec. 2016; 30: 227–237.
  • 13. Hilton AK, Jones D, Bellomo R. Clinical review: the role of the intensivist and the rapid response team in nosocomial end‐of‐life care. Crit Care 2013; 17: 224.
  • 14. Marini JJ. Re‐tooling critical care to become a better intensivist: something old and something new. Crit Care 2015; 19 Suppl 3: S3.
  • 15. Venkatesh B, Mehta S, Angus DC, et al. Women in Intensive Care study: a preliminary assessment of international data on female representation in the ICU physician workforce, leadership and academic positions. Crit Care 2018; 22: 211.
  • 16. Modra LJ, Yong SA. Towards gender balance in the Australian intensive care medicine workforce. Med J Aust 2019; 211: 300–302.
  • 17. Warrillow S, Farley KJ, Jones D. How to improve communication quality with patients and relatives in the ICU. Minerva Anestesiol 2016; 82: 797–803.
  • 18. Anesi GL, Wagner J, Halpern SD. intensive care medicine in 2050: toward an intensive care unit without waste. Intensive Care Med 2017; 43: 554–556.
  • 19. Warrillow S, Farley K, Jones D. Ten practical strategies for effective communication with relatives of ICU patients. Intensive Care Med 2015; 41: 2173–2176.
  • 20. Bellomo R, Stow PJ, Hart GK. Why is there such a difference in outcome between Australian intensive care units and others? Curr Opin Anaesthesiol 2007; 20: 100–105.
  • 21. Peake S, Delaney A, French CJ. Evolution not revolution: the future of the randomised controlled trial in intensive care research. Med J Aust 2019; 211: 303–305.
  • 22. Haines KJ, Berney S, Warrillow S, Denehy L. Long‐term recovery following critical illness in an Australian cohort. J Intensive Care 2018; 6: 8.
  • 23. Secombe PJ, Brown A, Bailey MJ, Picher D. Diversity and equity within critical care: Indigenous Australians in intensive care. Med J Aust 2019; 211: 297–299.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.