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

Adam M Deane and Mary G White
Med J Aust 2013; 198 (6): 309. || doi: 10.5694/mja12.11354
Published online: 1 April 2013

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.

  • Adam M Deane1
  • Mary G White2

  • 1 Critical Care Service, Royal Adelaide Hospital, Adelaide, SA.
  • 2 Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA.

Correspondence: adam.deane@ adelaide.edu

Competing interests:

No relevant disclosures.

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