For hospitals facing severe budgetary pressures from reduced managed care reimbursement and fixed Medicare payments, the ICU represents a significant economic challenge. Patient care in ICUs accounts for 25% to 35% of hospital operating budgets, but ICUs often are marginal or money-losing operations, primarily due to "outlier" cases. These outliers account for 50% (even more in some cases) of ICU resource expenditures, and are frequently the result of clinical complications, many of which could be prevented through appropriate early intervention.

The ICU is characterized by 1) high patient acuity, 2) a national shortage of intensivists and critical care nurses, 3) the fragmentation of physician coverage, and 4) the lack of easily accessible, accurate data for patient care and clinical performance. These factors have effectively blocked hospital executives from achieving improvements in this arena, even as managed care has driven process efficiency in other hospital-based services.