The ground rules are that if they have a house officer available 24 hours a day in the hospital, and they provide adequate backup coverage, they're permitted to do it as long as their measured outcomes are within satisfactory parameters. Certain services, such as faculty medicine, have decided that all ICU patients will be cared for by one team. Each individual service gets to make its own decisions about who will provide care. All university and community patients except for Palo Alto Medical Clinic patients are taken care of by the same attending physician and same team of residents and fellows. The PA clinic has two attendings, Richard Chalker and David Carlson, and they are integrated into the ICU team and make rounds on their own patients.
Some services integrate care with a physician assistant.
Nurses get to know how a particular physician likes his or her patients managed. It hasn't changed much for CV surgery as long as I've worked here, and medicine has been the same. The most recent change was surgery going to the intensivist model about four or five years ago. Perhaps the most noticeable change was the addition, about 10 years ago, of the ICU fellows in medicine. I think what is a little different over time is that surgical subspecialties used to look after their own postsurgical patients more frequently than they do now.