TY - CHAP M1 - Book, Section TI - Intensive Care Unit Staffing A1 - Garland, Allan A1 - Gershengorn, Hayley Beth A1 - Manthous, Constantine A. A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. Y1 - 2015 N1 - T2 - Principles of Critical Care, 4e AB - Most studies addressing staffing of ICUs have had significant limitations, and this literature does not yet provide a consistent view of the best model to use. This subject is complicated by the fact that optimal ICU staffing may depend on ICU characteristics.Despite calls for all ICUs to function as closed-model units with intensivists as the primary physician of record, evidence supporting this view is contradictory. Likewise, studies of around-the-clock intensivist presence have not consistently shown that it is associated with superior outcomes.The data do not supply a consistent answer to the question of whether ICUs would obtain better outcomes if they added nurses to reduce their patient:nurse ratios.Increasingly, nonphysician providers are playing innovative roles in the ICU, and care provided by teams including nurse practitioners or physician assistants appears to be safe and comparable to that provided by other staffing models.The conditions of ICU staffing will continue to change under the stresses of shortages of a variety of health care workers relevant to ICU care, and increasing duty hour limitations for physician trainees. Nonphysician providers, innovative staffing models, telemedicine, and other technologies will be increasingly used to cope with these realities.Since only quantitative evaluation can tell us whether one staffing model is better than another, we need more research from multiple sites to develop a consistent and integrated understanding of this complex topic. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1107710753 ER -