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The beneficial effects of dedicated critical care specialist physician care on ICU mortality and costs have been clearly demonstrated in the literature:

• 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.
• 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.
• 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.

The Leapfrog Group, a consortium that includes Fortune 500 companies, JCAHO, CMS (formerly HCFA) and large insurers, has identified ICU staffing with dedicated intensivists as one of its three initial hospital safety measures (along with computer physician order entry and volume based hospital referral).

In addition to being a valuable resource, intensivists are in short supply (<10% dedicated intensivist care). With the increasing demands of an aging population this scarcity is expected to worsen. The Committee on Manpower for Pulmonary and Critical Care Societies (formed by the American College of Chest Physicians, the American Thoracic Society, and the Society of Critical Care Medicine) was created to examine the current and projected need for critical care services. Because of a projected increase in demand in conjunction with no increased supply of intensivists, the committee predicted a shortfall of specialist hours equal to 22% of demand as defined by existing staffing practices by 2020. Angus DC et al, Caring for the critically ill patient, Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA, 284:2762, 2000 If ICU physician staffing is expected to meet higher standards such as the Leapfrog guidelines, the shortfall will be even greater. (Pronovost, P, Waters H, Dorman, T, Impact Of Critical Care Physician Workforce For Intensive Care Unit Physician Staffing. Current Opinion in Critical Care. 7:456, 2001) Current measures intended to increase the supply of intensivists appear to fall far short of a solution to this problem. The eCareManager^™; system addresses this problem by leveraging intensivists over more ICU patients. This solution satisfies the Leapfrog ICU physician staffing standard (see ICU Physician Staffing Factsheet), and may represent the only viable means for US hospitals to achieve compliance and the improved outcomes provided by this care model.

The Agency for Health Care Research and Quality (AHRQ) has also recognized the benefit of intensivist care (Making Health Care Safer- A Critical Analysis of Patient Safety Practices), citing a 29-58% reduction in ICU mortality in units staffed by intensivists. AHRQ also reported that intensivist management was one of the safety measures with a high strength of evidence regarding impact and effectiveness; and a telemedicine model of ICU care was noted as a possible solution to the discrepancy between intensivist numbers and need. The ability of telemedicine to reduce the incidence of major complications in critical care medicine was demonstrated in a study by Rosenfeld and co-workers where risk-adjusted ICU mortality fell by 50% and complications decreased by 40%. (Intensive care unit telemedicine: alternate paradigm for providing continuous intensivist care. Critical Care Medicine. 28:3925; 2000)

Availability and speed of physician reaction

Immediately available expertise is not only an obvious advantage in patient care, it is also a key element in critical care nursing professional satisfaction. A study noted that 25% of pages placed through an indirect system from the ICU were associated with a response time = 29 minutes while an additional 25% required more than 15 minutes. (Moss M, Trow TK, Clardy N. Differences in the response times of pages originating from the ICU. Chest 116:1019; 1999) Furthermore, Dr. John Kenagy, a physician visiting scholar at the Harvard Business School has shown that "Nurses spend only a third of their time in patient care, while they spend two-thirds of their time hunting, documenting, and clarifying." (The Man Who Would Save Health Care, Forbes, 12/11/2000)

The eCareManager^™ solution provides immediate intensivist availability and supports the care process using the speed and reliability of electronic data transfer. The eICU^® provides a constant response capability for care issues that arise when onsite physicians are not available. Moreover, the intensivist can insure that the myriad of specialist physicians are utilized appropriately

Smart Alert systems and improved monitoring

Monitors are only useful when capable personnel interpret and act upon the data. VISICU's eSolutions provide a combination of air traffic control and on-board alerts to increase patient safety. eCareManager^™ Smart Alerts®; provide a mechanism for 'pushing' essential information onto the critical care radar screen for interpretation and reaction. While the number of variables that the human mind can successfully address is limited (4-7 data constructs) (Morris AH, Developing and Implementing Computerized Protocols for Standardization of Clinical Decisions, Ann Int Med, 132:373, 2000), smart alerts allow for hundreds of variables to be examined in many patients simultaneously. Furthermore, the eICU^® provides a platform to ensure that problems are responded to immediately. This creates redundancy in the critical care monitoring system escalated by Leape (Error in Medicine, JAMA, 272:1851; 1994).

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