CARING FOR THE CRITICALLY ILL PATIENT Physician Staffing Patterns and Clinical Outcomes in Critically Ill Patients

APPROXIMATELY 1% OF THE US gross domestic product is consumed in the care of intensive care unit (ICU) patients. Despite this considerable investment of resources, there is wide variation in ICU organization, and studies have suggested that differences in ICU organization may affect patient outcome. For example, staffing ICUs with critical care physicians (intensivists) may improve clinical outcomes. A conceptual model that explains this finding is that physicians who have the skills to treat critically ill patients and who are immediately available to detect and treat problems may prevent or attenuate morbidity and mortality. Staffing ICUs with intensivists may also decrease resource use because these physicians may be better at reducing inappropriate ICU admissions, preventing complications that prolong length of stay (LOS), and recognizing opportunities for prompt discharge. Intensive care unit staffing is typical of an organizational issue in health care in that, despite its potential importance in clinical and economic outcomes, it is not studied by using randomized trials. For example, the widely Author Affiliations and Financial Disclosure are listed at the end of this article. Corresponding Author and Reprints: Derek C. Angus, MB, ChB, MPH, 604 Scaife Hall, CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh, 200 Lothrop St, Pittsburgh, PA 15213 (e-mail: [email protected]). Caring for the Critically Ill Patient Section Editor: Deborah J. Cook, MD, Consulting Editor, JAMA. Advisory Board: David Bihari, MD; Christian BrunBuisson, MD; Timothy Evans, MD; John Heffner, MD; Norman Paradis, MD; Adrienne Randolph, MD. Context Intensive care unit (ICU) physician staffing varies widely, and its association with patient outcomes remains unclear.