Resident full-time specialists in the ICU: a survivable model?

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?

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?

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.