Patients with prolonged intensive care unit (ICU) length of stay, though few in number, consume as much as 50% of ICU resources. With increasing pressures for cost containment in health care, the availability of ICU beds may be jeopardized. To improve the efficiency of care for patients requiring a surgical intensive care unit (SICU) stay of 3 or more days, a multidisciplinary, highly "protocolized," Progressive Care Area was developed within the existing SICU environment. Entry into this area is limited to patients whose acuity level is not high by ICU standards, but too high for a general surgical floor. In designing the Progressive Care Area, we drew on a number of published management strategies-including total quality management concepts and our prior experience in establishing ventilator management teams. The Progressive Care Area has resulted in a reduction in both the frequency and variation of resources used. A Progressive Care Area within an existing ICU is a viable alternative for the care of the patients who have prolonged lengths of stay and are less acutely ill, and it significantly improves ICU efficiency.