Administration Support

The ICU is a resource intensive environment where administrative support for resource optimization is crucial for its successful operation. Although various physician staffing models of care exist, the evidence consistently points towards high-intensity physician staffing when aiming for the best possible outcomes for both the patient and the health system. The benefit has been shown in various ICU populations and usually takes the form of a mandatory consult or a closed ICU model. Other components of the model that should be considered include intensivist-to-bed ratio, a unit culture emphasizing patient safety, and consistent quality assurance or performance improvement activities. Increasing compliance with evidence-based interventions through 24-hour intensivist staffing, tele-ICUs, regionalization, protocols and decision-making tools, and advanced practice providers have been tried with varying results. The need to deliver critical care on the move is becoming inevitable for patients but carries high risk. Dedicated transport teams may be one way of decreasing adverse events during transport. The ultimate goal for the ICU would be to function as a high reliability organization and will require everything from a highly dedicated unit culture of excellence to visible support from the leadership.