1. © 2009 On the CUSP: STOP BSI ICU Physician Staffing

2. © 2009 Learning Objectives To review the evidence on the benefits of ICU physician staffing To explore strategies to improve ICU physician staffing

3. © 2009 Organizing Principles for Intensive Care

4. © 2009 Intensivists Reduce Mortality Costs Question is not Whether to but How to implement IPS

5. © 2009 Intensivists Reduce Mortality: Hospital Mortality Pronovost JAMA 2002

6. © 2009 Intensivists Reduce Mortality: ICU Mortality Pronovost JAMA 2002

7. © 2009 Net Savings of IPS for Hospitals in $000 Pronovost CCM 2004

8. © 2009 Leapfrog model Net savings for hospital $000 Conrad, Gardner 2004 Leapfrog report

9. © 2009 Net Savings per ICU day Leapfrog model $ Conrad, Gardner 2004 Leapfrog report

10. FOUR FORTUNE 500 COMPANIES JOIN EMPIRE BLUE CROSS and BLUE SHIELD TO RECOGNIZE AND REWARD HOSPITALS THAT ACHIEVE LEAPFROG SAFETY STANDARDS Insurer to Provide Bonuses to Hospitals Insurer to Provide Bonuses to Hospitals That Rapidly Adopt Proven Patient Safety Programs NEW YORK (10/18/01) – IBM, PepsiCo, Inc., Verizon Communications and Xerox Corporation announced today that they will join Empire Blue Cross and Blue Shield in an innovative program designed to save lives by providing financial incentives to hospitals that rapidly achieve proven patient safety standards.

11. © 2009 Key Attributes of Physician Staffing Present Posses skill/knowledge Communicates/works with team of caregivers Manages the ICU Little is known about the relative value of each attribute

12. © 2009Extremes 24 X 7 No Intensivist

13. © 2009 Team Care Avoid Open versus Closed debate – Both primary care and ICU physician add value Obtain financial support from hospital for physician staffing Create Compact of what is expected Include performance measures in contract Obtain admission and discharge authority

14. © 2009 Strategies for Implementing Intensivists Meet with medical staff – Review evidence – Discuss team approach rather than open closed Create Compact with hospital – Hospital to provide financial support – Intensivists will staff ICU, monitor and improve quality – Review performance quarterly

15. © 2009 How Can You Realize these Attributes without Intensivists Discuss alternative models – Hospitalist – Regionalization – NP/PA – Other Ensure a physician rounds on all patients every day Call list

16. © 2009 Action Plan Discuss with team and hospital your current ICU physician staff, are you meeting the 4 attributes Develop plan to enhance ICU physician staffing Ensure nurses know which physician to page for all patients at all times Create explicit Compact; hospital will provide financial support and physician will provide services

17. © 2009References Levy MM, Rapoport J, Lemeshow S, Chalfin DB, Phillips G, Danis M. Association between critical care physician management and patient mortality in the intensive care unit. Ann Int Med 2008;148:801-9. Pronovost PJ, Holzmueller CG, Clattenburg L, Berenholtz S, Martinez EA, Paz JR, Needham DM. Team care: beyond open and closed intensive care units. Curr Opin Crit Care 2006;12:604-8. Pronovost PJ, Needham DM, Waters H, Birkmeyer CM, Calinawan JR, Birkmeyer JD, Dorman T. Intensive care unit physician staffing: Financial modeling of the Leapfrog standard. Crit Care Med 2006;34:S18-24. Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 2002;288:2151-62. Pronovost PJ, Jenckes MW, Dorman T, Garrett E, Breslow MJ, Rosenfeld BA, Lipsett PA, Bass E. Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA 1999;281:1310-17.