Closed Vs. Open Intensive Care Unit: Impact Of Full-time Surgical Intensivists

The intensive care unit remains a large user of hospital resources, accounting for 25% to 30% of hospital costs, representing 1% to 2% of the gross national product (between $40 and $80 billion per year) despite the fact that intensive care unit beds represent only 5 to 10% of hospital beds [1,2,3,4,5,6]. It is well known that a small percentage of high-risk patients account for the largest proportion of surgical intensive care costs [7]. In 1984, Li and his associates demonstrated that the presence of on-site physicians, who were not intensivists, improved utilization and decreased mortality in an intensive care unit in a community hospital [8]. More recently, Brown and Sullivan have shown, in a retrospective analysis of two matched groups of patients, that a full-time critical care specialist makes a significant impact on the management of critically ill patients in a mixed intensive care unit by reducing overall intensive care unit mortality by as much as 52% and hospital mortality by 31% [9].