ICU Hospitalist Model Improves Quality of Care for Critically Ill Patients

Despite calls for board-certified intensivists to manage all critically ill patients, only a third of hospitalized ICU patients currently are seen by such a specialist—mostly because there are not enough of them to go around.^1,2 More and more hospitalists, especially those in community hospitals, are working in ICUs (see “The Critical-Care Debate,”). With the proper training, that can be a good thing for patients and hospitalists, according to a Research, Innovations, and Clinical Vignettes (RIV) abstract presented at HM12 in San Diego.³

Lead author and hospitalist Mark Krivopal, MD, SFHM, formerly with TeamHealth in California and now vice president and medical director of clinical integration and hospital medicine at Steward Health Care in Boston, outlined a program at California’s Lodi Memorial Hospital that identified a group of hospitalists who had experience in caring for critically ill patients and credentials to perform such procedures as central-line placements, intubations, and ventilator management. The select group of TeamHealth hospitalists completed a two-day “Fundamentals of Critical Care Support” course offered by the Society of Critical Care Medicine (www.sccm.org), then began covering the ICU in shifts from 7 a.m. to 7 p.m. The program was so successful early on that hospital administration requested that it expand to a 24-hour service.

An ICU hospitalist program needs to be a partnership, Dr. Krivopal says. Essential oversight at Lodi Memorial is provided by the hospital’s sole pulmonologist.

Preliminary data showed a 35% reduction in ventilator days and 22% reduction in ICU stays, Dr. Krivopal says. The hospital also reports high satisfaction from nurses and other staff. Additional metrics, such as cost savings and patient satisfaction, are under review.

“So long as the level of training is sufficient, this is an approach that definitely should be explored,” he says, adding that young internists have many of the skills needed for ICU work. “But if you don’t keep those skills up [with practice] after residency, you lose them.”

References

1. The Leapfrog Group. ICU physician staffing fact sheet. The Leapfrog Group website. Available at: http://www.leapfroggroup.org/media/file/Leapfrog-ICU_Physician_Staffing_Fact_Sheet.pdf. Accessed Aug. 29, 2012.
2. Health Resources & Services Administration. Report to Congress: The critical care workforce: a study of the supply and demand for critical care physicians. U.S. Department of Health & Human Services website. Available at: http://bhpr.hrsa.gov/healthworkforce/reports/studycriticalcarephys.pdf. Accessed Aug. 29, 2012.
3. Krivopal M, Hlaing M, Felber R, Himebaugh R. ICU hospitalist: a novel method of care for the critically ill patients in economically lean times. J Hosp Med. 2012;7(Suppl 2):192.