Staffing Models for the ICU: Open, Closed, MD, NP, or Telemedicine?

Research paper by Jacob T. Gutsche, Jesse M. Raiten

Indexed on: 12 Feb '13Published on: 12 Feb '13Published in: Current Anesthesiology Reports


Intensive care is an expensive endeavor, estimated to account for more than 4 % of health care expenditure in the USA. The cost of critical care services is expected to increase as the population ages and requires more ICU-level care. Intensivists are physicians specially trained in the care of critically ill patients. A large body of evidence indicates that involvement of intensivists in the care of critically ill patients improves clinical outcome and limits costs. Currently, only about one third of critically ill patients benefit from the care of a dedicated intensivist. This number is expected to increase because the Leapfrog Group, an organization representing a large consortium of health care purchasers, is working to financially reward hospitals with dedicated intensivist staffing. Several different models of critical care delivery exist, and there continues to be debate about the best way to provide care. In addition, a shortage of intensivists has led to a search for the best way to provide off-hours critical care coverage. This article reviews the evidence regarding intensivist-driven care, nighttime coverage, and telemedicine.