Authors: Paul E. Marik, Joseph Varon
A variety of intensive care units (ICU) staffing models exist, which to a large extent are based on local practice and economic factors rather than cost-effectiveness and the quality of care delivered. The organizational structure of ICU in the United States are usually classified according to two types of models, namely a low- or high intensity model, or an open- or closed ICU model. (1,2) In a low-intensity ICU, patients are managed by non-intensivists, however an intensivist may be consulted on some cases (open model), whereas in a high-intensity model intensivists are consulted on all patients (open model) or the intensivist assumes responsibility for the patient and directs all aspects of the care (closed model). The closed ICU structure is the predominant model in almost all Western nations. (3,4) There are significant organizational differences between open and closed ICU. Open units are those in which admission of patients to the ICU is uncontrolled and management of the patients is at the discretion of each attending physician (not an intensivist). Admissions are based on a first-come, first-served basis. As the attending of record does not have the time nor skills to provide “comprehensive critical care” he/she “portions off” the patients’ care to a number of organ specific sub-specialists.