title: The evolution of the intensivist: from health care provider to economic rationalist and ethicist.
abstract: In contrast to many open intensive care units (ICUs) in the United State, where "parent" units (sometimes with few intensive care skills) admit and manage their own patients, Australia has closed units in which the intensivist has primary control of patient care while the patient remains in the ICU. This difference is important because in Australia, by virtue of having control of the ICU, the intensivist can be made responsible not only for patients care, but for resource allocation and financial constraint. Australian intensivists are called upon daily to make difficult decisions about who will be admitted, prematurely discharged or transferred from ICUs, and when treatment will be restricted or withdrawn.
authors.affiliation: Intensive Care Unit and Hyoperbaric Service, The Alfred Healthcare Group, Prahran, VIC Australia.
authors.forename: C D
authors.initials: CD
authors.lastname: Scheinkestel
mesh_terms: D001315:Australia; D003363:Cost Control; D003695:Delivery of Health Care / Q000639:trends; D004992:Ethics, Medical; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D018579:Patient Selection; D040841:Resource Allocation; D028761:Withholding Treatment