Evaluating the impact of the Leapfrog Group's standard for Intensive Care Unit physician staffing

There is growing concern over the quality and escalating costs of health care in the US. This paper reviews the Leapfrog Group's ICU Physician Staffing (IPS) standard, summarizes evidence supporting the standard, reviews the cost of implementing the standard, and discusses the impact of the standard on critical care in the US. The IPS standard requires that all patients in adult or pediatric general medical and/or surgical ICUs be managed or co-managed by physicians certified in critical care medicine. A systematic review of the literature demonstrated high intensity physician staffing (e.g. intensivists manage all patients) was associated with a 30% reduction in hospital mortality and a 40% reduction in ICU mortality. Interviews with authors from 19 studies demonstrated that the IPS requirement for pager response and weekday and weekend hours were supported by the evidence. Cost savings estimates with IPS ranged from $510,000 to $3.3 million (greater savings in larger ICUs). The impact of the IPS is unknown, although most hospitals in the original 6 regional rollouts made efforts to implement IPS. Given the results from this study, if IPS were implemented nationally, up to 134,000 lives could be saved annually with most hospitals incurring a net savings.