Canadian Health&Care; Mall

The spectrum of admitting diagnoses is similar to what is encountered in other medical intensive care units and includes, among others, respiratory insufficiency, hepatic failure, cardiac decompensation and shock, massive bleeding, hyperglycemic and hypoglycemic emergencies, seizure disorders, stroke, and uremia. Approximately one half of the patients are ventilator-dependent at some point during their hospitalization. No surgical or postoperative patients are normally admitted to this unit. Two physicians alternate on a monthly basis in providing medical supervision. The nursing staff consist of 24 nurses who provide continuous coverage on the basis of three separate shifts. The number of nurses per shift varies with the number of patients admitted, but is never less than two. During the study period, a total of four physician-assistants were assigned to the unit, two at a time. Both physician-assistants were available during the day time, while night coverage was provided by on-call physicians. Patient workup and charting, however, remained the responsibility of the physician-assistants, even in the case of patients admitted at night.