Leapfrog and critical care: evidence- and reality-based intensive care for the 21st century.

In 2000, the Business Roundtable published its Leapfrog report, which contained suggestions for improving administration of critical care. The Leapfrog Group intends to influence health care policy by pressuring insurers and hospitals to implement its guidelines, and both internists and intensivists are likely to be affected if these recommendations are realized. This article outlines the Leapfrog standards for critical care and examines critically the evidence used to justify them. Aside from the guideline that all critically ill patients should be cared for by intensivists, Leapfrog's standards for critical care are based either on weak or no scientific evidence. Rather, most of the guidelines are grounded in common sense and rational extrapolation of the data; as such, they are a reasonable starting point for debate by physicians and policymakers about optimal methods of achieving intensivist-guided care of critically ill patients.