Impact of the Leapfrog Group's intensive care unit physician staffing standard.
OBJECTIVE
The aim of this study was to describe hospital efforts to meet the Leapfrog Group's intensive care unit (ICU) physician staffing (IPS) standard; compare adopters and committers with resisters relative to perceived benefits, barriers and motivating factors; and examine implementation strategies.


METHODS
Chief medical officers (CMO) and ICU directors at hospitals in 6 US regions were surveyed between August 2003 and January 2004. Hospital classifications were based on level of IPS implementation pioneer (met before IPS), adopter (met after IPS by 2002 Leapfrog survey), committer (not met but committed to December 2004 implementation), and resister (refused to adopt IPS). Meeting IPS included intensivist staffing, 8 hours/day 7 days/week; sole patient care in ICU; 95% pager response time </=5 minutes; and physicians certified in critical care.


RESULTS
Forty-three (80%) CMOs and 42 (78%) ICU directors were interviewed. Adopters (100%), committers (80%), and resisters (45%) employed intensivists; 1 adopter (14%) met all criteria for standard. Main motivators for implementation were "quality of patient care" for CMO (79%) and ICU director (71%) adopter/committers. Incentives to implement were increasing intensivist authority (90% committers) and intensivist salary support (80% committers and 70% adopters). Main resister barriers were implementation costs (61% CMOs) and medical staff controversy (55% ICU directors).


CONCLUSIONS
Most hospitals-including half of those who publicly resisted the standard-made attempts to change physician staffing in their ICUs, based on the criteria outlined by the Leapfrog Group. Major barriers that need addressing are implementation costs and convincing hospital organizations and medical staff regarding the benefits of adopting the standard.
Pronovost
Peter
P
Department of Anesthesiology and Critical Care Medicine, Quality & Safety Research Group, The Johns Hopkins University, School of Medicine, Baltimore, MD 21231, USA. ppronovo@jhmi.edu
Thompson
David A
DA
Holzmueller
Christine G
CG
Dorman
Todd
T
Morlock
Laura L
LL
D001291:Attitude of Health Personnel; D019538:Health Care Surveys; D006284:Health Plan Implementation; D006801:Humans; D007362:Intensive Care Units; D008505:Medical Staff, Hospital / Q000592:standards*; D009936:Organizational Innovation; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D011787:Quality of Health Care; D012308:Risk Management; D014481:United States; D000078329:Workforce