Medical Post - Open versus Closed ICU.

The concept of an Intensive Care Unit (ICU) was first developed over 50 years ago during the Copenhagen polio epidemic. This produced a large number of very ill patients with breathing difficulties who needed special life support. The practice of putting all the most ill patients into one area in the hospital was established. Over the years some doctors and nurses began to spend more and more of their time treating these very sick patients. They developed an "interest" in intensive care. In 1999 ICU was finally recognised as a medical specialty in its own right . As a result specialty trained “intensivists” were employed to care for patients in ICU. In the UK these intensivists are usually anaesthetists, and this reflects the leaps in technology which occurred allowing support for heart, lungs, circulation, kidneys etc. in very sick patients. Soon, these intensivists specialized in an area of acute medicine that had advanced so far that general physicians and surgeons no longer retained the competencies to practice ICU.
An "open" ICU is one where the attending physician or surgeon continues to care for his patient(s) even after they have deteriorated enough to require ICU admission. A "closed" ICU is one where a fully trained intensivist takes over most of the care of the patient whilst in the ICU. He/she makes decisions relating to the care and medical management of the patient until they finally leave the unit and return to the care of the original physician or surgeon. Evidence shows that changing from an "open" to a "closed" type ICU model can lead to a 30 to 60% reduction in patient deaths! That means that for every 10 patients who die on an ICU, 3 to 6 could survive if this change were to be made! It hardly seems surprising that having a specially trained intensive care doctor, managing patients day in day out on an ICU might be better than a "generalist" who dabbles now and then! Consequently, around the developed world, the vast majority of ICUs have changed from the "open" to the "closed" type model.
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