Closed vs. open unit

[NeuroNP]

How many of you work in a closed unit? That is, only the "intensivist" service can admit to your unit. Do you think it works better than the open model? I've read a lot lately to suggest that patients do better in this type of environment when they ahve a dedicated intensivist caring for them (either medical or surgical) and I would think that the unit would run better in that all your patients are being cared for by the same team. Comments?

[traumaRUs, MSN, APRN]

We went to the intensivist and hospitalist approach due to the fragmentation of the pt care. The intensivist is the "Captain of the Ship" and as such has a better overall handle on the pt care.

[ZASHAGALKA, RN]

Ours is modified. Our pulmonologists are our 'intensivists'. Every group but the cardiologists must consult them as 'intensivists' within 36 hrs of admit to CCU.

IF they don't, by rules of the medical committee, they are written up and the pulmonologists are consulted automatically by protocol at hour #37. If they continue to ignore the policy, they can lose admitting privileges to CCU.

So it's a short term 'open' unit, but long term 'closed'. And the pulmonologists will be the first to admit that alot of things can be screwed up in that first 36 hrs that can take days and weeks to correct.

BTW, I came here because I thought you were talking about visitation policies, and I bet I won't be alone. . .

~faith,

Timothy.

[christianRN]

This is an interesting idea. Although we have nothing in writing, most docs consult an intensivist or pulmonologist when their patients are admitted to the unit, but there have been a few times when they haven't been consulted and they should have been. Was this pushed by the hospital, or the intensivists? Do you have a group of intensivists contracted to cover the unit, or do the other docs just pick who they want?