At this time there are insufficient data to answer these important questions. However, considering the likely reasons for superior clinical outcomes with dedicated intensivist staffing may provide some useful insights and identify areas for future study. First, intensivists, as a result of their training and clinical activities, have greater familiarity and expertise in managing critically ill patients. This expertise presumably leads to more accurate and timely problem recognition and better management decisions, regardless of whether these activities are provided on-site or remotely. Second, dedicated ICU physicians coordinate the diverse tasks of the care team (consultants, nursing, pharmacy, respiratory, nutrition, etc.), establish priorities, and create a comprehensive care plan. This important activity, setting the care plan, usually occurs at the beginning of each day. Because it is time consuming and entails integrating large amounts of data (including physical exam findings) and communicating with multiple care providers and the patient's family, one might hypothesize that this activity is better performed by on-site physicians. Third, dedicated intensivists monitor each patient's progress throughout the day (altering therapies as needed to ensure that care objectives are met), and detect and respond to new problems promptly. This constant adjustment of care can only occur when intensivists monitor patients continuously, analyze new data as they become available, and respond immediately when changes in therapy become necessary. It is this continuous monitoring of patient status that is at the heart of the dedicated intensivist model. Because of their inherent physiologic instability, ICU patients sustain adverse events and develop complications at rates far exceeding those of other patients. Only through continuous monitoring by highly trained physicians can we ensure that patients progress according to plan and receive appropriate and timely treatment of all problems. We hypothesize that this continuous care function, which requires 24-hour 7-day physician vigilance, can be performed effectively by intensivists regardless of their location, and represents the optimal use of this new technology.