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Does Care by Intensivists Improve Outcomes in the ICU?

Mortality was lower and length of stay was shorter in ICUs with mandatory intensivist involvement than in those without mandatory involvement.

Study results suggest that physician staffing patterns affect clinical outcomes in intensive care units. In this systematic review, researchers evaluated the association between clinical outcomes in the ICU and the participation of critical care specialists (intensivists). Staffing was classified as either high intensity (i.e., all care directed by intensivists, or mandatory intensivist consultation) or low intensity (i.e., elective intensivist consultation, or no intensivist available).

Twenty-six relevant studies were identified; most were cohort studies in which researchers compared outcomes before and after new staffing arrangements were implemented. High-intensity staffing was associated with significantly lower ICU mortality (relative risk, 0.61) and hospital mortality (RR, 0.71). High-intensity staffing also was associated with significantly shorter hospital length of stay in 6 studies and significantly shorter ICU length of stay in 11 studies. In contrast, low-intensity staffing was associated with significantly shorter hospital and ICU stays in only 1 study.

Comment: Although ICU staffing has not been addressed in randomized trials, these results strongly suggest that mandatory participation of intensivists improves the quality of care in ICUs. However, recent data indicate that staffing is low intensity in most ICUs in the U.S. Barriers to high-intensity staffing most likely include a shortage of intensivists and resistance to change at some institutions. The Leapfrog Group, a large coalition of organizations that provide health care benefits for employees, has made ICU staffing by intensivists one of its top priorities.

— Allan S. Brett, MD

Published in Journal Watch General Medicine November 19, 2002

Citation(s):

Pronovost PJ et al. Physician staffing patterns and clinical outcomes in critically ill patients: A systematic review. JAMA 2002 Nov 6; 288:2151-62.

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