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Physician Staffing Models and Patient Safety in the ICU

Ognjen Gajic, MD, FCCP; Bekele Afessa, MD, FCCP
Author and Funding Information

*From the Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.

Correspondence to: Bekele Afessa, MD, FCCP, 200 First St SW, Rochester, MN 55905; e-mail afessa.bekele@mayo.edu


No financial or personal support from organizations with financial interest in the subject matter of the manuscript was obtained. Dr. Gajic has no conflicts of interest to disclose. Dr. Afessa has no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

For editorial comment see page 892


Chest. 2009;135(4):1038-1044. doi:10.1378/chest.08-1544
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Despite the manpower shortage to care for the critically ill, the number of ICU beds has been rising for the last 2 decades. The ICU intensivist physician staffing model is still in flux in this country. Despite a challenge by a recent single publication, numerous studies have shown that high-intensity intensivist staffing improves patient outcome in the ICU. However, 73% of the ICUs in this country provide low-intensity or no intensive care coverage. Although it may not be possible to implement 24 h/d intensivist coverage of all ICUs at this time, we believe it is the best model for achieving good patient outcome. The mere presence of intensivists in the ICU is unlikely to improve patient outcome unless it is associated with the creation of an organizational environment ideal for the implementation of evidence-based practice. In this commentary, we will discuss the available evidence behind the current models and express our opinions about current and future ICU intensivist staffing.


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