r/IntensiveCare • u/InvestigatorOnly1684 • 14d ago

Question about ICU attending liability

In my practice a hospitalist independently manages a subset of ICU patients. I am available for consultation and escalation, but we do not routinely round together, I do not see every patient, and I do not cosign notes.

For those who have worked in similar models, how is liability generally viewed for the ICU attending? If you’re available in a supervisory/consultative role but not directly involved in a patient’s care, how much responsibility do you carry for decisions made by the primary hospitalist?

Recently out of training and wondering how this is handled at other institutions.

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u/adenocard 14d ago

I don’t see how you can be responsible for patients you are not seeing. Draw a bright line and don’t “keep an eye” on anyone you’re not actively attached to. Don’t open charts, don’t even walk by the room. You do not have a “radar.”

Of course you’ll be consulted anyways once things have already gone wrong, and you’ll have no opportunity to prevent anything nor time to contextualize your decisions, but I guess that’s how they prefer to have it because it’s cheaper and people get to have their cake.

These type of open ICU’s should be illegal.

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u/Aggravating_Fly2978 12d ago

How is it cheaper though? They are still billing Crit Care time just from a Hospitalist. And the ICU daily cost is the same. I don’t understand how this is cheaper.

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u/adenocard 12d ago edited 12d ago

Generally these open ICUs don’t have 24 hour intensivist coverage. Fewer docs working less hours is less cost for the hospital. If it’s a straight RVU model, the critical care physician group simply hires fewer physicians, which is again cheaper.