ICU physicians save hospitals money

05/26/04

The financial model's best-case scenario demonstrated savings of up to $13 million

DES PLAINES, Ill.- Hospitals, even those with small intensive care units (ICU), would save money by implementing the intensive care unit (ICU) physician staffing standard, according to an article in the June issue of Critical Care Medicine.

"Using conservative cost estimates, annualized savings available to hospitals with small, six bed ICU are $500,000, a 12 bed ICU $2 million and an 18 bed ICU $3 million," said lead author Peter J. Pronovost, M.D., Ph.D., associate professor of anesthesiology and critical care, surgery, health policy and management, as well as medical director of the Center for Innovations in Quality Patient Care at The Johns Hopkins University School of Medicine in Baltimore. The figures include the salaries of the ICU physicians, or intensivists.

Intensivists are board certified in a medical specialty such as surgery, internal medicine, pediatrics, or anesthesiology, and have received special training and subspecialty certification in critical care. They are dedicated to the ICU and remain on the unit for the duration of their assigned coverage.

The Leapfrog Group's intensive care unit physician staffing standard requires ICUs to have a dedicated intensivist present in the ICU at all times during the day and immediately available at night by pager. A physician must be in the hospital and able to reach ICU patients immediately.

Several large U.S. healthcare purchasers formed The Leapfrog Group to initiate breakthroughs in patient safety and to improve the overall value of healthcare to U.S. consumers.

The researchers used published data combined with conservative assumptions to create financial models of cost and savings for 6-, 12-, and 18-bed intensive care units staffed under this ICU physician staffing standard.

The authors found that annual cost savings would range from $510,000 to $3.3 million for 6- to 18-bed ICUs. A best-case scenario demonstrated an annual savings of $4.2 to $13 million. Under the worst-case scenario, there was a net cost of $890,000 to $1.3 million.

Implementation of dedicated intensivist staffing in non-rural American adult intensive care units is estimated to save 162,000 lives annually. Nonetheless, there has been little organized effort to implement intensivist staffing in the United States. A targeted survey of hospitals revealed that dedicated intensivist staffing is currently employed in only 10 percent - 20 percent of U.S. ICUs. This and other failures to translate clinical research into actual practice have resulted in preventable illness and death and may have shortened life expectancy in the U.S., according to the investigators.

"In addition to reducing costs, intensivist staffing has repeatedly proven to be one of the most effective critical care interventions," said Dr. Pronovost. "It reduces hospital mortality by 30 percent."

Three main barriers to implementing the intensivist model exist. The first obstacle is financial because of the hesitancy of hospital management to assume intensivists' salaries. A second concern is upsetting medical staff and the final barrier is a presumed shortage of intensivists.

Dr. Pronovost does not entirely accept these impediments. "Our research has shown that financial concerns can be eliminated," he said. "Hospital leadership can overcome the political barrier by practicing patient-centered rather than provider-centered leadership. Given the clinician and economic benefits of intensivist staffing, hospital leaders should ensure the patients in their ICUs receive the life saving intervention available through appropriate intensivist staffing. While there is an intensivist shortage, the magnitude of this shortage is unknown. Estimates of the shortage are based on current ICU staffing models rather than an intensivist model. I have seen several hospitals implement an intensivist model without hiring new intensivists by simply integrating existing physician groups."

"Hospitals need to ensure that critically ill patients have access to this life saving intervention. To realize these benefits, ICU must be appropriately staffed with intensivists," Dr. Pronovost concluded.

In 1998, several large U.S. healthcare purchasers formed The Leapfrog Group to initiate breakthroughs in patient safety and to improve the overall value of healthcare to consumers. The Leapfrog Group has grown to include more than 34 million employees from more than 105 major U.S. corporations, representing in excess of $59 billion in annual healthcare expenditures. Using this financial influence, The Leapfrog Group seeks to create a business case for improved quality in healthcare by rewarding high-quality providers with preferential use and by helping employees make more informed hospital choices based on indicators of high-quality care.

"The Society for Critical Care Medicine has advocated for intensivist-led, multi-disciplinary critical care for the past 30 years," said Joseph E. Parrillo, M.D., editor-in-chief of Critical Care Medicine. "The research supporting our position continues to grow."

Source: Eurekalert & others

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