title: Resident full-time specialists in the ICU:  a survivable model?
abstract: OBJECTIVE
  Intensivists have a professional and personal interest in trying to answer whether immediate review of patients by a consultant intensivist improves outcomes. Although some advocate in-hospital around-the-clock consultant intensivist presence, does the available evidence suggest all ICUs should be staffed in such a manner and is such a service sustainable given the shortage of intensivists, potential loss of staff from burnout and cost?
  
  
  RESULTS
  We present in narrative form the background and recent literature for a consultant resident service in terms of the ethical tenets of nonmaleficence, beneficence, autonomy and justice. Nonmaleficence - what is the evidence it is bad for patients not to provide a resident service? Beneficence - what is the evidence a resident intensivist service is good for patients? Autonomy - is it in intensivists' own interests to provide a 24-h service? And justice - is it a justifiable use of healthcare resources?
  
  
  CONCLUSIONS
  A unified staffing solution within a country's different ICUs, let alone between countries, is unlikely. The current evidence does not universally support or justify 24  h/7 days consultant intensivist presence. International differences in staffing models and ICU structures make direct comparisons difficult and in some circumstances the balance may favour 24  h/7 days consultant intensivists.
authors.affiliation: Aneurin Bevan Health Board, Royal Gwent Hospital, Newport, Wales, UK. Jack.parryjones@wales.nhs.uk
authors.forename: Jack
authors.initials: J
authors.lastname: Parry-Jones
authors.forename: Allan
authors.initials: A
authors.lastname: Garland
mesh_terms: D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency; D017146:Models, Organizational; D010561:Personnel Staffing and Scheduling; D012017:Referral and Consultation; D013038:Specialization; D000078329:Workforce