Table 1 Arguments for why full-time, on-site specialists in the ICU improve care and efficiency

expenses).

•

Dedicated team members are more motivated to perform well, because they are directly responsible.

•

Special, expert consultation (e.g. clinical pharmacologists or bacteriologists) is more effective.

•

Standardised, optimised procedures and protocols can be defined and be better fulfilled by a closed team:

•

Standardised weaning strategies or protocols: Mechanical ventilation in ICM has become increasingly sophisticated (e.g. protective lung

ventilation). Errors in ventilation strategy are expensive (e.g. barotrauma, ventilator-induced lung injury). Weaning protocols may shorten

length of stay in ICU.

•

Treatment protocols, e.g. for sedation: Sedation is expensive and requires continuous observation and experienced personnel. Errors in

sedation are even more expensive (they increase the length of stay)!

•

Standardised, optimised procedures for antibiotics: Infections are expensive and increase the length of stay. Rational antibiotic strategies

can be carried out more effectively.

•

Hygiene measures can be better controlled in a closed team (protocol implementation). Direct supervision is possible.

•

Standardised protocols for managing nutrition can be more cost-effective.

•

Complications of invasive monitoring can be reduced by a dedicated ICU team: Experience in inserting, controlling, and maintaining invasive

catheters is built up. Insertion techniques (e.g. for pulmonary artery catheters) can be standardised. Experience is gained in using the results

for therapeutic decisions and to identify errors and artefacts.

•

Uniform admission and discharge policies: The members of the ICU team are more familiar with the patient's history and actual situation (e.g.

hidden complications, physiological stability, stress reaction).