ICU Physician Staffing

Key Facts about Intensive Care Units (ICUs)
More than 4 million patients are admitted to intensive care units (ICUs) each year in the US. An ICU is a consolidated area of a hospital where patients with acutely life-threatening illnesses or injuries receive specialized medical and nursing care, such as mechanical ventilation and invasive cardiac monitoring, around-the-clock.

Mortality rates in patients admitted to the ICU average 10-20% in most hospitals. Overall, approximately 500,000 patients die in US ICUs each year.

There is evidence of a direct correlation between the level of training of ICU personnel and the quality of patient care. When ICUs are staffed with physicians who have credentials in critical care medicine or when intensive care specialists are available to respond to 95% of pages within five minutes, the risk of patients dying in the ICU has been shown to reduce by more than 10%.

Given the high stakes involved, quality of care in ICUs is particularly important. Unfortunately, evidence suggests that quality varies widely across hospitals.


ICU Physician Staffing (IPS)
A growing body of scientific evidence suggests that quality of care in hospital ICUs is strongly influenced by 1) whether "intensivists" are providing care, and 2) staff organization in the ICU.

Intensivists are physicians who focus their medical practice on the care of critically ill and injured patients. After their initial training in internal medicine, surgery, or anesthesiology, intensivists become board-certified by completing additional training focused in critical care (for more information, go to www.sccm.org). In the process, they become familiar with the complications that can occur in the ICU and thus are better equipped to minimize errors.
Mortality rates are significantly lower in hospitals with closed ICUs managed exclusively by board-certified intensivists. Apart from saving lives, intensivist model ICUs may also reduce ICU lengths of stay and the number of unnecessary ICU admissions.


The Leapfrog IPS Safety Standard
National experts in quality improvement advised the Leapfrog Group to focus on ICU physician staffing (IPS) as one of its initial Safety Standards because of the potential benefits for patients. The IPS Standard was established after review of published research in the field and consultation with leading experts in intensive care.

Hospitals fulfilling this standard assure that all patients in their adult general medical and surgical ICUs are managed or CO-managed by physicians certified (or eligible for certification) in critical care medicine who:
1.    Are present during daytime hours and provide clinical care exclusively in the ICU and
2.    At other times can, at least 95% of the time,
            a.    Return ICU pages within five minutes and
            b.    arrange for a FCCS-certified physician or physician extender to reach ICU patients within five minutes.

The Leapfrog Group, working in partnership with The MEDSTAT Group, will invite hospitals with ICUs to certify to the Leapfrog web site that their systems meet the IPS Standard.

How do area hospitals do on Leapfrog safety measures such as CPOE?
Go to the Leapfrog website and enter your Zip Code or city to find out.


Challenges to IPS Implementation
It is estimated that today only 10% of ICUs in the US would meet Leapfrog's IPS standard. In some hospitals without IPS, non-intensivist physicians may be simply unwilling to relinquish care of their patients in the ICU to intensivists.

Alternatively, hospitals may be unable to hire intensivists because of a shortage of available trained personnel. Many teaching hospitals have decreased the size of their fellowship programs in critical care for financial reasons, thus limiting the supply of new certified intensivists. Also related to reimbursement issues, many board-certified intensivists are choosing not to work in the ICU.

In addition, hospitals with small units may lack the "economies of scale" necessary to support full-time intensivists for their ICU. Thus, implementing the IPS on a broad scale may require consolidating ICU care in larger hospitals, instead of implementing IPS at all hospitals currently without it.