We appreciate the interest in our article by Carlson et al. Interns in several specialties were available on a continuous basis in the intensive care units (ICUs) studied. Second- or third-year internal medicine residents had duties outside the ICU, particularly during nights, weekends, or holidays. It is not correct to assume that all procedures or minute-to-minute direction of therapy was provided by house officers, and we addressed this issue in our discussion. We acknowledge this area as being important for comparison of care offered by the attending physicians and one that cannot be fully clarified without repeating a study at a site without house officers. Even at such a site, one might argue that minute-to-minute management of care by competent critical care nurses would obscure differences in care provided by attending physicians not continuously on-site.The studies cited that purportedly demonstrate that continuous on-site physician staffing in ICUs
Hainer BL, Lawler FH. Comparison of Critical Care by Family Physicians and General Internists-Reply. JAMA. 1989;261(2):243–244. doi:10.1001/jama.1989.03420020095021
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