title: The organization of intensive care unit physician services.
abstract: OBJECTIVE
  To describe the organization of physician services in intensivist-staffed intensive care units (ICU) reporting that they meet vs. do not meet the Leapfrog Physician Staffing standard, and to describe ICU directors' perceptions of the quality of care in their unit.
  
  
  METHODS
  Hospitals that were asked to participate in the 2001 and 2002 Leapfrog surveys regarding implementation of the ICU Physician Staffing standard were sampled. Survey instruments were developed and used to determine organizational characteristics, status regarding implementing and meeting the standard, financing of physician staffing, and perceptions of clinical performance.
  
  
  METHODS
  ICU directors.
  
  
  RESULTS
  Intensivists staffed ICUs in 100% of hospitals meeting the standard, and in 59% not meeting the standard. Mean percentage of patients visited on rounds by intensivists in ICUs who met (80 +/- 14.58) vs. did not meet (57.5 +/- 23.20) the standard showed no statistical difference, Wilcoxon rank-sum test = -1.99, p = .065. Only 25% (three of 12) of intensivists in ICUs meeting the standard had authority to write patient orders on all patients, compared to 65% (11 of 17) in ICUs not meeting the standard. Intensivists were present at least 8 hrs/day in 83% (ten of 12) of ICUs meeting and 18% (three of 17) of ICUs not meeting the standard. Provision of medical liability insurance for physicians occurred in 58% (seven of 12) of ICUs meeting and 25% (four of 16) of ICUs not meeting the standard (p = .003). ICU directors rated quality of ICU care as excellent in 70% of ICUs meeting and 35% of ICUs not meeting the standard.
  
  
  CONCLUSIONS
  ICUs now classify themselves as meeting or not meeting the ICU Physician Staffing standard. Yet, there is wide variation in organizational characteristics among ICUs meeting the standard, and between those meeting and not meeting the standard. The criteria defined by the Leapfrog Group for meeting the ICU Physician Staffing standard must be clearly defined if hospitals are to meet the standard.
authors: School of Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. ppronovo@jhmi.edu
authors: Peter J
authors: PJ
authors: Pronovost
authors: David A
authors: DA
authors: Thompson
authors: Christine G
authors: CG
authors: Holzmueller
authors: Todd
authors: T
authors: Dorman
authors: Laura L
authors: LL
authors: Morlock
mesh_terms: D003422:Critical Care / Q000458:organization & administration*; D007362:Intensive Care Units / Q000458:organization & administration*; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D014481:United States; D000078329:Workforce