ETHICAL, LEGAL AND ORGANIZATIONAL ISSUES IN THE ICU: Edited by Julian BionResident full-time specialists in the ICU: a survivable model?Parry-Jones, Jacka; Garland, AllanbAuthor Information aAneurin Bevan Health Board, Royal Gwent Hospital, Newport, Wales, UK bSection of Critical Care Medicine, University of Manitoba Health Sciences Center, Winnipeg, Manitoba, Canada Correspondence to Jack Parry-Jones, FRCP, FRCA, FFICM, Intensive Care Consultant, Aneurin Bevan Health Board, Royal Gwent Hospital, Newport, NP20 2UB, Wales, UK. Tel: +44 1 633 234 678/7 974 746 783; fax: +44 1 633 656 067; e-mail: [email protected] Current Opinion in Critical Care: December 2012 - Volume 18 - Issue 6 - p 677-682 doi: 10.1097/MCC.0b013e32835909ed Buy Metrics Abstract Purpose of review Intensivists have a professional and personal interest in trying to answer whether immediate review of patients by a consultant intensivist improves outcomes. Although some advocate in-hospital around-the-clock consultant intensivist presence, does the available evidence suggest all ICUs should be staffed in such a manner and is such a service sustainable given the shortage of intensivists, potential loss of staff from burnout and cost? Recent findings We present in narrative form the background and recent literature for a consultant resident service in terms of the ethical tenets of nonmaleficence, beneficence, autonomy and justice. Nonmaleficence – what is the evidence it is bad for patients not to provide a resident service? Beneficence – what is the evidence a resident intensivist service is good for patients? Autonomy – is it in intensivists’ own interests to provide a 24-h service? And justice – is it a justifiable use of healthcare resources? Summary A unified staffing solution within a country's different ICUs, let alone between countries, is unlikely. The current evidence does not universally support or justify 24 h/7 days consultant intensivist presence. International differences in staffing models and ICU structures make direct comparisons difficult and in some circumstances the balance may favour 24 h/7 days consultant intensivists. © 2012 Lippincott Williams & Wilkins, Inc.