UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Crit Care Med. 2012 Oct;40(10):2754-9. doi: 10.1097/CCM.0b013e31825b26ef.
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.
To determine whether improved outcomes in specific quality measures would result in an overall cost savings in patient care
Retrospective, 1 yr before-after cohort study
A 15-bed mixed medical-surgical community intensive care unit
A total of 2,181 patients: 1,113 patients preimplementation and 1,068 patients postimplementation.
Leapfrog intensive care unit physician staffing standard
Intensive care unit and hospital length of stay, rates for ventilator-associated pneumonia and central venous access device infection, and cost of care.
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%.
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.
先前的研究表明，实施莱普格（Leapfrog）加强医疗单位医师人力配置标准，即配置专门的重症监护医师提供 24 小时重症监护病房服务，可降低住院时间和院内死亡率。重症监护病房医师人力配置模式的成本效益理论模型也已发布，但尚无研究检验此类方案的实际成本与成本节约。
确定特定质量指标的改善是否会导致患者护理的总体成本节约。
回顾性，实施前后 1 年队列研究。
15 张病床的混合内科-外科社区重症监护病房。
共有 2181 名患者：实施前 1113 名，实施后 1068 名。
莱普格加强医疗单位医师人力配置标准。
重症监护病房和医院的住院时间、呼吸机相关性肺炎和中央静脉置管感染的发生率以及护理成本。
在实施重症监护病房医师人力配置后，重症监护病房的平均住院时间从 3.5±8.9 天显著减少至 2.7±4.7 天（p<.002）。干预后，呼吸机相关性肺炎的发生率从 8.1%降至 1.3%（p<.0002）。每 100 个呼吸机日的呼吸机相关性肺炎发生率从 1.03 降至 0.38（p<.0002）。干预后，中央静脉置管感染事件的发生率从 9.4%降至 1.1%（p<.0002）。每 1000 个导管日的中央静脉置管感染率从 8.49 降至 1.69。医院的净节省为 744,001 美元。重症监护病房医师人力配置的 1 年机构投资回报率为 105%。
实施莱普格加强医疗单位医师人力配置标准可显著缩短重症监护病房住院时间，并降低呼吸机相关性肺炎和中央静脉置管感染的发生率。成本分析得出的 1 年机构投资回报率为 105%。我们的研究证实，在社区医院环境中实施莱普格重症监护病房医师人力配置模式可改善质量指标，并且在经济上是可行的。
