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Evidence supports the superiority of closed ICUs for patients and families: No

Intensive Care Medicine January 1, 2017

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Research Areas


In “closed” intensive care units (ICUs), primary responsibility for admitted patients is transferred to an intensivist. In “open” units, the attending physician of record is typically a non-intensivist from another service who may have a longitudinal relationship with the patient and who may or may not consult an intensivist for assistance with management. Open staffing models are much more common in North America, whereas closed models predominate in Europe.

On its face, it seems obvious that a trained intensivist would provide higher quality intensive care than a physician trained in a different area. Yet, perhaps surprisingly, there exists no compelling evidence that this premise is true. As a result, clinicians, policymakers, patients, and families cannot be sure which models to advocate. Most of the available research comes from North America where full implementation of “high intensity” staffing (closed and/or 24-h intensivist coverage) staffing models has proved impractical given workforce limitations. More than a decade ago, the Leapfrog group recommended mandatory intensivist management of all critically ill patients, yet recent guidelines from the American College of Critical Care Medicine are more circumspect. What can we make of the available evidence?


National Heart, Lung, and Blood Institute