Pro/Con debate: should 24/7 in-house intensivist coverage be implemented?

Area of Science:

• Medical Management
• Healthcare Operations
• Intensive Care Medicine

Background:

• Academic medical centers require robust staffing for intensive care units (ICUs).
• A new multi-disciplinary ICU is adopting a closed, intensivist-led model.
• Decisions regarding intensivist scheduling impact unit sustainability and quality of care.

Purpose of the Study:

• To compare the sustainability of 24/7 in-house intensivist coverage versus remote home coverage.
• To inform the scheduling decisions for intensivists in a new academic ICU.

Main Methods:

• The study involves a conceptual analysis of two intensivist coverage models.
• Consideration of factors influencing sustainability, such as resident/fellow availability and operational demands.

Main Results:

• In-house coverage offers immediate response but may strain resources.
• Remote coverage can improve work-life balance but may delay critical interventions.
• Sustainability depends on balancing resident training needs with attending workload.

Conclusions:

• The optimal model requires careful consideration of patient acuity, resident education, and intensivist well-being.
• A hybrid approach may offer a sustainable solution for academic ICUs.