Quality improvement and cost savings after implementation of the Leapfrog intensive care unit physician staffing standard at a community teaching hospital


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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 careDesign:Retrospective, 1 yr before-after cohort studySetting:A 15-bed mixed medical-surgical community intensive care unitPatients:A total of 2,181 patients: 1,113 patients preimplementation and 1,068 patients postimplementation.Intervention:Leapfrog intensive care unit physician staffing standardMeasurements: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.

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