Do intensivists in ICU improve outcome?

Despite considerable investment of resources, there remains wide variation in organization of Intensive Care Units (ICUs). One key domain is the physician staffing. In particular, does staffing with physicians trained in critical care (intensivists) improve clinical outcomes? The rationale for improved outcome with intensivist staffing is that physicians who have the skills to treat critically ill patients, and who are immediately available to detect and treat problems, may prevent or attenuate morbidity and mortality. Intensivist staffing may also yield benefits through a leadership role at the intensive care unit organizational level. The improved sense of continuity and close attendance to patients may also bolster improved patient and family satisfaction. Intensivist-led or intensivist-staffed ICUs may also realize decreased resource use because these physicians may be better at reducing inappropriate admissions, preventing complications that prolong length of stay, and recognizing opportunities for prompt discharge.