title: Quality improvement and cost savings after implementation of the Leapfrog intensive care unit physician staffing standard at a community teaching hospital.
abstract: BACKGROUND
  Prior studies have shown that implementation of the Leapfrog intensive care unit physician staffing standard of dedicated intensivists providing 24-hr intensive care unit coverage reduces length of stay and in-hospital mortality. A theoretical model of the cost-effectiveness of intensive care unit physician staffing patterns has also been published, but no study has examined the actual cost vs. cost savings of such a program.
  
  
  OBJECTIVE
  To determine whether improved outcomes in specific quality measures would result in an overall cost savings in patient care
  
  
  METHODS
  Retrospective, 1 yr before-after cohort study
  
  
  METHODS
  A 15-bed mixed medical-surgical community intensive care unit
  
  
  METHODS
  A total of 2,181 patients: 1,113 patients preimplementation and 1,068 patients postimplementation.
  
  
  METHODS
  Leapfrog intensive care unit physician staffing standard
  
  
  METHODS
  Intensive care unit and hospital length of stay, rates for ventilator-associated pneumonia and central venous access device infection, and cost of care.
  
  
  RESULTS
  Following institution of the intensive care unit physician staffing, the mean intensive care unit length of stay decreased significantly from 3.5±8.9 days to 2.7±4.7 days, (p<.002). The frequency of ventilator-associated pneumonia fell from 8.1% to 1.3% (p<.0002) after intervention. Ventilator-associated pneumonia rate per 100 ventilator days decreased from 1.03 to 0.38 (p<.0002). After intervention, the frequency of the central venous access device infection events fell from 9.4% to 1.1% (p<.0002). Central venous access device infection rate per 1000 line days decreased from 8.49 to 1.69. The net savings for the hospital were $744,001. The 1-yr institutional return on investment from intensive care unit physician staffing was 105%.
  
  
  CONCLUSIONS
  Implementation of the Leapfrog intensive care unit physician staffing standard significantly reduced intensive care unit length of stay and lowered the prevalence of ventilator-associated pneumonia and central venous access device infection. A cost analysis yielded a 1-yr institutional return on investment of 105%. Our study confirms that implementation of the Leapfrog intensive care unit physician staffing model in the community hospital setting improves quality measures and is economically feasible.
authors: UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA. amayparikh@gmail.com
authors: Amay
authors: A
authors: Parikh
authors: Shirley A
authors: SA
authors: Huang
authors: Praveen
authors: P
authors: Murthy
authors: Viktor
authors: V
authors: Dombrovskiy
authors: Michael
authors: M
authors: Nolledo
authors: Ray
authors: R
authors: Lefton
authors: Anthony T
authors: AT
authors: Scardella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000191:economics / Q000517:prevention & control; D017046:Cost Savings / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D006745:Hospital Bed Capacity, 300 to 499; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000458:organization & administration; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D010820:Physicians / Q000458:organization & administration*; D053717:Pneumonia, Ventilator-Associated / Q000191:economics / Q000517:prevention & control; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration*; D012189:Retrospective Studies