Potential reduction in mortality rates using an intensivist model to manage intensive care units.

CONTEXT Because of evidence suggesting that outcomes are better in "intensivist-model" intensive care units (ICUs), the Leapfrog Group's hospital safety standards propose that ICUs be managed by critical care physicians (intensivists) who work exclusively in the ICU. COUNT Number of lives saved annually in the United States. CALCULATION Lives saved = (number of ICU admissions x in-hospital mortality rate of ICU patients) x reduction in mortality rates associated with the intensivist model. DATA SOURCE Reduction in mortality rate associated with intensivist-model ICUs was determined by performing a structured literature review from 1986 to the present using MEDLINE. Other variables were estimated from various data sources. RESULTS In the nine studies that met our selection criteria, relative reductions in mortality rates associated with intensivist-model ICUs ranged from 15% to 60%. On the basis of the most conservative estimate of effectiveness (15% reduction), full implementation of intensivist-model ICUs would save approximately 53,850 lives each year in the United States. CAUTIONS: Given the large number of ICU patients and their high baseline risks, even modest reductions in mortality rates would save many lives. Because of potential constraints related to the workforce and other resources, the feasibility of fully implementing intensivist-model ICUs nationwide is uncertain.