The question of who is actually responsible for the decisionmaking in intensive care is an ongoing debate in critical care medicine. Traditionally in Australia the intensive care specialist takes responsibility for all decisionmaking for the patients under their care, and refers to the primary team only for consultation on specific questions, or for specialist services (eg. angiography, surgery, endoscopy etc). This model is supported by our robust (nightmarish, exhausting, arbeit macht frei) training program which produces world-class intensive care physicians. However, the primary team's desire to have active input into the care of their patients is a source of conflict, and it must be acknowledged that many ICUs in developed countries function reasonably well without intensivists.
Question 26 from the second paper of 2007 asked the candidates what they understood by "open" and "closed" ICUs, and what are the advantages/limitations of each. As the pass rate was around 60%, most candidates understood this fairly well. This bodes well for their future practice. Australian ICUs tend to be all "closed", with the exception of private hospitals where it seems the admitting surgical specialist can make (occasionally disastrous) decisions which countermand whatever the staff intensivist has recommended, making it a de facto open model. The reason for such openness is the imbalance of power in private institutions, where the surgeons are dominant revenue-bringers. As the chief money-makers, their influence over clinical decisions tends to be more supported by the executive staff whenever a dispute arises. It is economically more sensible to jettison the troublemaking intensivist then to risk losing the surgeon.
Anyway. As far as useful resources go, there is some material out there:
Oh's manual has surprisingly little to say on this matter, presumably because in the opinion of the authors the matter is settled. A paragraph is devoted to the issue on page 6, where the Pronovost (2002) review is quoted in support of thew closed model.
Definition of "open" and "closed" ICU models
Advantages of a "closed" ICU
Advantages of an "open" ICU
Evidence in support of the closed model
Evidence in support of the open model
Some synthesis of the above
We don’t have‘his’ or ‘her’ patients, we have ‘our’ patients, and in the event that the home team feels that there may be aspects of our treatment that require explanation, we are only too happy to discuss this with them — civilly."
Pronovost, Peter J., et al. "Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review." Jama 288.17 (2002): 2151-2162.
Levy, Mitchell M., et al. "Association between critical care physician management and patient mortality in the intensive care unit." Annals of internal medicine 148.11 (2008): 801-809.
Wilcox, M. Elizabeth, et al. "Do Intensivist Staffing Patterns Influence Hospital Mortality Following ICU Admission? A Systematic Review and Meta-Analyses*." Critical care medicine 41.10 (2013): 2253-2274.
Wallace, David J., et al. "Nighttime intensivist staffing and mortality among critically ill patients." New England Journal of Medicine 366.22 (2012): 2093-2101.
Checkley, William, et al. "Structure, process, and annual ICU mortality across 69 centers: United States critical illness and injury trials group critical illness outcomes study*." Critical care medicine 42.2 (2014): 344-356.
Capanni, Francesca, and William Checkley. "Differences in Hospital Mortality by ICU Staffing Models: You Cannot Always Get What You Want, but Sometimes You Get What You Need*." Critical care medicine 41.10 (2013): 2433-2434.
Carson, Shannon S., et al. "Effects of organizational change in the medical intensive care unit of a teaching hospital: a comparison of'open'and'closed'formats." Jama 276.4 (1996): 322-328.
Hackner, Dani, et al. "Do faculty intensivists have better outcomes when caring for patients directly in a closed ICU versus consulting in an open ICU?." Hospital practice 37.1 (2009): 40-50.
Ghorra, Salim, et al. "Analysis of the effect of conversion from open to closed surgical intensive care unit." Annals of surgery 229.2 (1999): 163.
Brilli, Richard J., et al. "Critical care delivery in the intensive care unit: defining clinical roles and the best practice model." Critical care medicine 29.10 (2001): 2007-2019.
Worthley, L. I. "The ideal intensive care unit: open, closed or somewhere between?." Critical Care and Resuscitation 9.2 (2007): 219.
van der Sluis, Frederik J., et al. "The impact of open versus closed format ICU admission practices on the outcome of high risk surgical patients: a cohort analysis." BMC surgery 11.1 (2011): 18.
Weissman, Gary E., and Scott D. Halpern. "Evidence supports the superiority of closed ICUs for patients and families: no." (2016): 1-4.
Vincent, Jean-Louis. "Evidence supports the superiority of closed ICUs for patients and families: yes." (2016): 1-2.
Guidet, B., N. Kentish-Barnes, and H. Wunsch. "Evidence supports the superiority of closed ICUs for patients and families: we are not sure." (2016): 1-3.