TUESDAY, Nov. 5, 2002 (HealthDayNews) -- Here's a study where the conclusion seems obvious from the start: Tens of thousands of lives could be saved every year if America's intensive care units were fully staffed with doctors trained in critical care medicine.
However, with only 10 percent of such patients getting that kind of care, reaching that goal will not be easy, say the researchers. Most of them are members of a specialty whose name is unfamiliar and whose history is short: intensivist, a critical care specialist.
"There is fairly overwhelming evidence that full-time interventionists should man intensive care units (ICU)," says Dr. Derek C. Angus, an associate professor of critical care medicine and health policy management at the University of Pittsburgh. He is the lead author of the study, which appears in tomorrow's Journal of the American Medical Association. "The problem is that it is not clear how you can do it. There is no easy way to staff every facility in America with full-time intensivists." The first board examination in critical care medicine was given as recently as 1987, he notes.
So why do the study?
"To gather data supporting the value of intensivists and put it into the published literature so that it can be input in an ongoing debate about our health-care system," says Dr. Todd Dorman, an associate professor of anesthesia and critical care medicine at the Johns Hopkins Bloomberg School of Public Health and another member of the study team.
Or as Angus puts it, the idea is to point out that "it is unacceptable not to worry about how you provide coverage in intensive care units."
One statistic shows the need to worry about that coverage, says Maurene Harvey, the first intensive care nurse to be president of the Society of Critical Care Medicine. "Twenty percent of Americans die in intensive care units. We don't let nurses work in the ICU unless they are trained in critical care medicine, but we do let physicians without that training work there," she says.
The generally accepted estimate until now has been that full intensivist staffing of ICUs would save 54,000 lives a year, Harvey says. However, the new study raises that figure considerably, to 162,000 lives. That number is understandable given the fact that there are 6,000 ICUs in the United States caring for 55,000 patients every day, Harvey adds.
To arrive at the number of lives that could be saved, the researchers combed the medical literature and came up with 26 studies of ICU staffing strategies and the resulting effect on patients. They found that high-intensity staffing was associated with a lower ICU death rate in 14 of 15 studies, with an overall 39 percent lower risk of death. Intensive staffing also reduced the length of stay in 14 of 18 studies, which would translate into billions of dollars of savings.
While individual institutions may be motivated to make changes because of this study, "this is an organizational issue in health care," Dorman says. "This is an issue that is not related to the doctor-patient relationship. It will be up to hospitals and schools of medicine and health-care institutions to be partners in changing organizational structures."
A number of strategies have to be considered, Angus says. One would be "to make more rational use of the ICU," sorting out those patients who need critical care from those who might not. Another would be to trim costs by using "physician extenders," trained personnel other than doctors.
They are available, says Harvey, and include physician's assistants and nurse practitioners trained in critical care medicine. "You have to organize a team," she says.
"Before we spend more money, we should at least make sure we organize and deliver the services we provide as rationally as possible," Angus says.
What To Do
You can get an overview of the field from the Society of Critical Care Medicine. You can also read this article about how intensivists are making a difference at some hospitals in Wisconsin.