Team care: beyond open and closed intensive care units.
OBJECTIVE
Evidence supporting dedicated intensivist staffing in intensive care units is growing. Despite clinical and economic benefits, medical staff politics and a shortage of intensivists impede the intensivist model. The purpose of this paper is to accelerate patient's exposure to the benefits of intensivists, and introduce team care in the intensive care unit.


RESULTS
The cost savings achieved through intensivist staffing range from $510,000 to $3.3 million. The intensivist model may only have been adopted by 4% of intensive care units. Barriers to implementing the model are shortage of intensivists, reimbursement for intensivists, and political will. Four attributes make the model ideal: physical presence, knowledge of critical care practice, coordination of team care, and unit management. It may be helpful to not label intensive care units as open or closed and consider team care, whereby hospitals seek to achieve the attributes of the model given their resources and culture.


CONCLUSIONS
Intensivists save lives and costs. By working toward team care, hospitals may achieve a successful intensivist model, and patients may realize the benefits of spending less for healthcare and living longer. To achieve this model, physician and hospital leaders must form a partnership.
Pronovost
Peter J
PJ
Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland 21231, USA. ppronovo@jhmi.edu
Holzmueller
Christine G
CG
Clattenburg
Lia
L
Berenholtz
Sean
S
Martinez
Elizabeth A
EA
Paz
Jose Rodriguez
JR
Needham
Dale M
DM
D017046:Cost Savings; D004470:Economics, Medical; D006280:Health Workforce; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010820:Physicians / Q000600:supply & distribution; D013038:Specialization