Impact of intensivists and ICU teams on patient outcomes

We present a review of the impact of intensivists and ICU teams on patient outcomes, with specific emphasis on varying hospital environments and study designs. While the demand for critical care services is likely to increase , 50% of ICU patients still receive care from nonintensivists in conjunctio n with consultants. While no "standard" of critical care practice exists, c osts are substantial: there are about 55,000 ICU patients/day in the United States, and organizational structures vary substantially. ICU outcome stud ies can be divided into three groups: multi-institutional comparisons, befo re-and-after studies, and side-by-side comparisons. Multi-institutional com parisons have tended to show improved outcomes in well-organized ICUs, with strong medical direction and on-site intensivists. The change from an "ope n" to a "closed" format for ICU care is associated with decreased low-acuit y admissions, resource utilization and mortality rates, and improved effici ency. Side-by-side com parisons have demonstrated improved efficiency decre ased complications, and decreased resource use on ICU services directed by an intensivist.