Percentage Open vs Closed ICU in Real World

[TexasBoy]

Outside of the Academic World...

... what percentage of ICUs do you think are open versus closed? (In private practice that is).

During my ICU months I seem to perfer closed ICUs, but is it just something that's mainly in academic centers or does it actually appear in private practice?

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[KGUNNER1]

I haven't taken a formal survey, but my best guess, from discussions at various conferences, is that in small-medium sized hospitals the units are open. Some will have a "tiered" level of intensivist involvement (full management to "just make the recommendations and I'll decide if I want to follow") and some will have mandatory intensivist consults.

I think most hospitals are at least trying to build up intensivist programs (Leap Frog initiatives and some insurance company pressure) and there are more pure hospital based critical care groups forming.

Still, the largest number of critical care bills submitted to Medicare remains from non-specialist Internal Medicine docs, most likely in open units.

kg

 

[TexasBoy]

Thanks, that good to know. I've only been in large referral centers and was uncertain about its representation to what I'll actually be seeing (I'm likely going to apply to pulm/CC fellowship and then work as an intensivist