A Resident Consultant Service in Intensive Care: A Shift in the Right Direction? A Resident Consultant Service in Intensive Care: A Shift in the Right Direction?

. It is difficult to see how, in units with 2 or 3 times this number of beds, a single consultant can safely maintain asimilar standard of practice. The adult critical careservice in the UHW comprises 29 beds (excludingcardiac intensive care) and admits approximately2,500 patients per annum. As is commonplace in the UK, on-call consultants would bear sole responsibility for the management of the unit after normal working hours and at weekends. The unpredictable nature of intensive care practicemeans that the after-hours component of consultantwork can be particularly onerous. While consultantsfrom other specialities can curtail after-hours activityby appropriate scheduling of routine work, such asoutpatient clinics and elective surgery, similar opportunities do not exist in intensive care.Furthermore, the critically ill patient frequentlyrequires that the consultant is present at the bedside rather than just giving telephone advice.The situation is not helped by systematic deficiencies in the provision of care for the criticallyill. Difficult triage decisions routinely arise as a resultof under provision of critical care beds coupled withincreased demands on the service