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Should hospitals have intensivist consultants in-house 24 hours a day? – Yes

Onsite intensivist support is needed to improve clinical decisions and safety

An intensive care unit (ICU) is only as good as the care and decision making provided at 2 am. If we believe that intensivists really make a difference to patient outcomes, surely extended hours of onsite intensivist cover are necessary? A patient-centred approach to staffing that takes into account the potential for human error is needed. Most Australian ICUs are staffed after-hours by registrars. Some are not vocational trainees. Experience and clinical skill is variable. Onsite intensivist support tends to be concentrated throughout the day, with the on-call specialists often required to be onsite for 12 hours or more and on-call overnight. Challenges exist in providing uniform levels of clinical expertise around the clock to ICU patients while maintaining a healthy and safe work routine for clinicians.

The ICU is a complex operating environment that requires high-risk decision making day and night. Early work on errors in the ICU emphasised adverse incidents; current research concentrates on diagnostic error. A recent systematic review of autopsy studies on ICU patients found an important incidence of critical misdiagnosis including vascular events and infections.1 Other missed diagnoses included pulmonary embolus,…