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Should hospitals have intensivist consultants in-house 24 hours a day? – No

Twenty-four-hour coverage is costly, has not demonstrated benefit and diminishes the quality of intensivists’ training

At first glance, proposals for having an in-house consultant intensivist providing 24-hour care have some appeal. It has been suggested that because daily intensivist input improves outcomes in the critically ill, moving from an after-hours consultation service to a 24-hour presence onsite would improve the quality of health care.1 However, this belief is purely speculative and is not supported by data. It is important to recognise that in other areas of medicine, treatments require a certain “dose”, and when given in excess of this dose there is no further improvement. For example, excessive administration of what some may consider relatively benign therapies, such as oxygen, intravenous fluid and enteral nutrition, has no benefit and indeed can be harmful beyond a certain dose. The optimal “dose” of an intensivist remains uncertain.

Before introducing major structural changes to a system, its problems should be identified, and the solution provided should have the potential to fix or ameliorate the problems. Accordingly, if onsite intensivists are the solution, there must be a problem with the current level of care provided to the critically ill, and the problem…