Establishing an organized system of ICU care has improved ICU mortality and length of stay. The ICU care team and executive ledership should work towards developing systems that assure continuous improvement. In this regard, the type of physician caring for critically ill patients matters.
ICU’s are traditionally described as “open” or “closed” units. Open units are those ICU’s where any physician in virtually any field may see a patient and write orders on that patient. Doctors of any stripe may admit patients to these ICU’s with few limitations. Doctors are not required to obtain critical care consultations.
Closed ICU’s are those where physicians are required to admit patients to an intensive care service. Physicians must allow the ICU staff physicians to be the primary care agents for the patient ultimately responsible for all medical decision making. Other disciplines, including the general medicine or family practice service, may consult on the patient during the ICU stay.
Reorganizing ICU physician services in one organization by implementing an intensivist infrastructure has resulted in a 14 percent absolute risk reduction in mortality. [1]
References:
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Pronovost P, Berenholtz S. A Practical Guide to Measuring Performance in the Intensive Care Unit. VHA Research Series 2002; (2):29.
