Toward the ideal ratio of patients to intensivists: Finding a reasonable balance

Alongside the increased number and complexity of ICU patients has been the development and common use of intensivists to staff ICUs. Intensivists are the hospitalists of the ICU-physicians who dedicate much or all of their clinical practice to the ICU, and who take primary responsibility (or an aggressive “consult” comanagement) for patients while they are in the ICU. Although there is only ambiguous evidence of better outcomes with intensivists,3 the practical necessity of having physicians who are readily available for emergencies, capable of handling ventilators, complicated hemodynamics, and coordinating complex multidisciplinary care and quality improvement in the ICU has resulted in their growing adoption.