Intensivists Reduce Mortality And Length Of Stay In ICU Patients
PITTSBURGH, November 5, 2002 — The greater use of intensivists, physicians who specialize in the management of critically ill patients, in intensive care units (ICUs) significantly reduces ICU mortality, hospital mortality and length of stay, according to a study published by University of Pittsburgh School of Medicine and Johns Hopkins University School of Medicine researchers in the Nov. 6 issue of the Journal of the American Medical Association.
“There are approximately 6,000 ICUs in the United States, caring for 55,000 critically ill patients each day. Annual ICU costs are approximately $180 billion. Despite this large investment, there is no standard model for how an ICU should be staffed or organized,” said Derek C. Angus, M.B., Ch.B., M.P.H., associate professor and vice chair of research, department of critical care medicine, University of Pittsburgh School of Medicine. “By staffing ICUs with physicians specifically trained in critical care medicine, most importantly we can save lives, but we can also conserve our resources. Intensivists can help reduce inappropriate ICU admissions, prevent complications that increase length of stay and recognize opportunities for prompt discharge.”
In the study, researchers reviewed published data from controlled trials of critically ill adults or children. From this data, they identified ICU physician staffing as being low-intensity, where no intensivist was on staff or where intensivist consultation was merely elective, or as being high-intensity, where an intensivist consultation was mandatory or where an intensivist directed all care.
High-intensity ICU staffing was associated with lower hospital mortality in 94 percent of the applicable studies and lower ICU mortality in 93 percent of the applicable studies. High-intensity staffing also reduced length of hospital stay in 77 percent of the applicable studies and reduced length of ICU stay in 78 percent of the applicable studies.
“These findings deliver an important message to hospitals in the United States about the importance of intensivists to the quality of patient care. The percentage of ICU patients in the United States who are being treated by intensivists is alarmingly low – studies show that only 10 percent of ICUs in the United States require intensivists to act as a patient’s primary physician and that an estimated one-third of all ICU patients are treated by intensivists,” said Peter J. Pronovost, M.D., Ph.D., associate professor, department of anesthesiology and critical care medicine, Johns Hopkins University School of Medicine. “This study supports the importance of intensivists in the ICU and the need for more research and systematic reviews of the impact of intensivist staffing in the ICU.”
According to the researchers, this study supports existing recommendations for increased ICU physician staffing made by the Society for Critical Care Medicine and the Leapfrog Group, a Business Roundtable-sponsored commitment to mobilize employer purchasing power to initiate breakthrough improvements in health care. Both groups feel that the staffing of ICUs with physicians trained in critical care medicine is necessary and will cause a significant increase in quality of care and decrease in medical errors.