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December 4, 1996

Comparison of the 'Open' vs 'Closed' Intensive Care Unit Formats

Author Affiliations

St Luke's-Roosevelt Hospital Center New York, NY

JAMA. 1996;276(21):1721. doi:10.1001/jama.1996.03540210029020

To the Editor.  —A disturbing finding in the article by Carson et al1 is that the availability of emotional support for patients decreased significantly under the closed ICU system, and continuity of care was rated as poorer by house staff and attending physicians. This "cost" was borne by patients and their families (whose response rate to the interview unfortunately was poor) so that teaching could improve and rounds could be interrupted less frequently. Even the nurses, who are reported to have more confidence under the closed system, had a less than 50% rate of being "very confident" in the clinical judgment of the closed system physicians.An article by Hansot2 points out that, from the patient's perspective, many problems exist when critical care is provided by specialists who are not familiar with the patient and his or her values and preferences. It is time to wake up to the needs of