Is 24/7 In-House Intensivist Staffing Necessary in the Intensive Care Unit?

Publisher: Methodist DeBakey Heart & Vascular Center Country of Publication: United States NLM ID: 101508600 Publication Model: Print Cited Medium: Internet ISSN: 1947-6108 (Electronic) Linking ISSN: 19476108 NLM ISO Abbreviation: Methodist Debakey Cardiovasc J Subsets: MEDLINE

Original Publication: Houston, TX : Methodist DeBakey Heart & Vascular Center

Critical Care*/economics ; Critical Care*/organization & administration ; Delivery of Health Care, Integrated*/economics ; Delivery of Health Care, Integrated*/organization & administration ; Intensive Care Units*/economics ; Intensive Care Units*/organization & administration ; Personnel Staffing and Scheduling*/economics ; Personnel Staffing and Scheduling*/organization & administration; Medical Staff, Hospital/*supply & distribution; Cost Savings ; Cost-Benefit Analysis ; Health Services Needs and Demand ; Hospital Costs ; Humans ; Job Description ; Medical Staff, Hospital/economics ; Medical Staff, Hospital/organization & administration ; Needs Assessment ; Time Factors ; Workflow ; Workforce

Over the past few decades, an increasing number of studies have shown that intensivist-staffed intensive care units (ICUs) lead to overall economic benefits and improved patient outcomes, including shorter length of stay and lower rates of complications and mortality. This body of evidence has convinced advocacy groups to adopt this staffing model as a standard of care in the ICU so that more hospitals are offering around-the-clock intensivist coverage. Even so, opponents have pointed to high ICU staffing costs and a shortage of physicians trained in critical care as barriers to implementing this model. While these arguments may hold true in low-acuity, low-volume ICUs, evidence has shown that in high-acuity, high-volume centers such as teaching hospitals and tertiary care centers, the benefits outweigh the costs. This article explores the history of intensivists and critical care, the arguments for 24/7 ICU staffing, and outcomes in various ICU settings but is not intended to be a comprehensive review of all controversies surrounding continuous ICU staffing.
Competing Interests: Conflict of Interest Disclosure: Dr. Masud is a consultant for Mallinckrodt Pharmaceuticals and Chiesi USA, Inc.

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Keywords: 24/7 staffing; ICU; advanced practice provider; critical care unit; intensive care unit; intensivist

Date Created: 20180707 Date Completed: 20181029 Latest Revision: 20181202

20231215

PMC6027728

10.14797/mdcj-14-2-134

29977470