Oncologic critical care units specialize in the care of patients with critical illness related to their malignancy, treatment, or other conditions. Intensive care unit (ICU) beds, utilization, and costs have continuously increased in general acute care hospitals in the United States over the past three decades. This chapter reviews and summarizes current literature related to ICU beds, utilization, and costs in general and oncologic critical care units as well as recommendations to improve access, quality, and costs of healthcare. The concept of the specialty ICU and its associated outcomes is briefly covered. Evidence-based recommendations of best practices for ICU resource optimization are delineated. In conclusion, effective critical care organizations will develop and align the multiple facets of research, quality improvement, culture of safety, and outcomes to improve the value of critical care units in healthcare delivery.