When Timothy Buchman, M.D., president of the Society of Critical Care Medicine, extracts the data from a recent study linking physician staffing of intensive care units and patient outcomes, he comes up with a startling conclusion.
According to Buchman, co-director of the surgical ICU and director of the trauma center at Barnes Jewish Hospital in St. Louis, Mo., each week more Americans die from a lack of intensivist care than died in the terrorist attacks on the World Trade Center.
That research, published last year in the Journal of the American Medical Association, adds to a growing body of literature showing mortality rates are significantly lower when critical care is managed by board-certified intensivists.
"If we, as a nation, are concerned about longevity and the quality of care being delivered, we need to examine the intensivist model," says Buchman,
ICUs account for 5% to 15% of total hospital beds but are responsible for 25% to 35% of average hospital costs.
Almost 5 million Americans are treated in intensive care each year at a cost of about $180 billion. And about 500,000 of those patients die in the ICU, where critical care mortality rates in most hospitals average 10% to 20%, according to the Leapfrog Group.
This evidence has led the Leapfrog Group to focus on ICU physician staffing as one of its key hospital-safety standards. Yet, due to the shortage of trained critical care experts, and, in some cases, resistance from admitting physicians, only an estimated 10% of U.S. hospitals today are able to meet the Leapfrog standard.
According to Buchman, even if every hospital opted for the model, there are only enough intensivists to cover 15% to 20% of the ICU beds in the country. And the shortage of qualified critical care personnel exists across the whole multispecialty spectrum, including nurses, pharmacists, respiratory therapists and other allied health professionals.
That is where an electronic ICU system pioneered by physician-led Visicu, a critical care technology firm based in Baltimore, Md., comes in.
This technological solution addresses both the shortage of critical care professionals and quality improvement. By applying the principles of telemedicine, an off-site team can monitor individual patients, analyze data and provide computer-assisted decision support to the on-site ICU staff.
In current practice, the eICU allows one intensivist and one critical care nurse to track 50 patients. Its creators believe as many as 200 patients could be monitored from one eICU.
"The data presented is such that it can facilitate patient rounds and make more efficient and more effective the doctors who are in the ICU," says Brian Rosenfeld, M.D., who co-founded Visicu with fellow former Johns Hopkins intensivist Michael Breslow, M.D.
Rosenfeld emphasizes that the system is not intended to be a replacement for human care. He says it is most effective as a supplement to an on-site intensivist who makes rounds, sets the care plans, then goes to the office or operating room.
The financial and outcomes results at Visicu's first site, the six-hospital Norfolk, Va.-based Sentara Healthcare system, are winning converts nationwide.
Rodney Hochman, M.D., senior vice president and CMO of Sentara, confirms that mortality decreased 20% and length of stay was reduced by 17% in the two years following the June 2000 installation of the system at 664-bed Sentara Norfolk General Hospital.
In the first nine months, cost per patient decreased by $2,150, according to an analysis by Cap Gemini Ernst & Young. The analysts reported that the eICU generated an annual savings of $4.9 million on the initial program investment of $1.9 million, or a 155% return on investment.
Hochman says the return may be even greater due to some unintended benefits.
"We put the system in small hospitals where we had difficulty getting doctors to admit and operate. Now they are full," Hochman says. "When you include support, you improve market share and the OR schedule. We were hoping things like that would happen, but we didn't count on them."
Hochman says the hourly rate paid to doctors who staff the eICU is the major expense, after hardware and software. But he says improvement in staff satisfaction and fewer vacancies will more than pay for increased staffing costs.
"We follow nursing retention rates, and the earliest measures show we improved dramatically in the units with the eICU," he says. "That's a big deal with hard-to-retain critical care nurses."
Improving the life of intensivists nearing burnout also may add years to the careers of these sought-after physicians.
Intensivist Gene Burke, M.D., has practiced with the Sentara eICU since its inception. In the old days, he says his beeper went off every 30 to 45 minutes when on call, making him sleep-deprived, less sharp and less pleasant. Now Burke sends his calls to the eICU after 9: 30 p.m.
"I've been doing this for 20-some years and was plenty tired," he says. "I was looking at backing off to the office to do just pulmonary care. (The eICU) has added years to my practice because it has made the job more manageable. My phone never goes off at night and I sleep soundly even though I am on call. My quality of life is improved. My nights are more mine, and I get pulled away less during the days."