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The Intensivist's Role in the ICU

Intensivists create better outcomes for critically ill patients. VISICU's thrust in developing the eICU® Program and eCareManager™ software has been to use technology to enable intensivists to reach more patients more of the time.

Intensivists are physicians with advanced certification training and experience in critical care. Typically they have completed a fellowship in critical care after serving a residency in internal medicine, pulmonary medicine, anesthesia, or surgery.

Numerous studies have demonstrated that intensivist involvement in the care of ICU patients leads to double-digit improvement in patient outcomes, and the Leapfrog Group (an association of Fortune 500 companies) has called for full-time intensivist staffing as a way to save more than 50,000 lives per year.

Unfortunately, there are less than 6,000 actively practicing intensivists in the United States. This shortage severely limits their impact nationwide: less than 15% of ICU patients have dedicated intensivists, and more than 50% of ICU patients have no intensivists at all.

Remote intensivist management was validated for feasibility and effectiveness in a 1997 trial at an urban, academic-affiliated community hospital in Baltimore. The results were: a 55% reduction in severity-adjusted ICU mortality, a 45% reduction in outlier patients, a 40% reduction in clinical complications, and a 30% reduction in ICU LOS (view published results.)

References

1. Angus D, Kelley M, Schmitz R, et al: Caring for the critically ill patient. Current and projected workforce requirements for the care of the critically ill and patients with pulmonary disease. JAMA 284 (21):2762-70, 2000.
2. Hanson CW, Deutschman CS, Anderson HL, et al: The effect of an organized critical care service on outcomes and resource utilization: A prospective cohort study. Crit Care Med 27 (2):270-274, 1999.
3. Manthous CA, Amoateng-Adjepong Y, Al-Kharrat T: Effects of a medical intensivist on patient care in a community teaching hospital. Mayo Clin Proc 72:391-99, 1997.
4. Milstein A, Galvin R, Delbanco S, et al: Improving the safety of health care: The Leapfrog Initiative. Eff Clin Pract 3 (6):313-6, 2000.
5. Pronovost P, Jenckes MW, Dorman T, et al: Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA 281 (14):1310-1317, 1999.
6. Pronovost PJ, Angus DC, Darman T, et al. Physician staffing patterns and clinical outcomes in critically ill patients. A systematic review. JAMA 2002; 288:2151-2162.
7. Rosenfeld B, Dorman T, Breslow M, et al: Intensive care unit telemedicine: Alternate paradigm for providing continuous intensivist care. Crit Care Med 28 (12):3925-31, 2000.