[Intensive care medicine and its place among the medical specialties]

The cost of providing intensive care is enormous. This resource consumption is focused on a relatively small number of patients. Over the past 30 years, despite new technologies and escalating costs, mortality rates for major disease conditions treated in the intensive care units remain unchanged. The studies done on organizational aspects of intensive care medicine do provide a strong argument that full-time intensivists improve the organization of intensive care, reduce mortality and increase efficiency of resource use. There are two general models of intensive care organization: open and closed. In the open model, an intensivist, if available, may provide consultation in particular department as needed. For patients with complex illness or prolonged length of stay, open systems are fragmented and poorly co-ordinated. In contrast, the closed system involves transfer of the patient to the exclusive care of a team of intensivists upon admission to the intensive care unit. The closed system typically provides formal triage, and consistent control, and mandated care by the intensivist team. Significant reductions in mortality rates and improvements in resource efficiency are seen with use of intensivist teams, a closed intensive care unit model and systematic triage.