When Doylestown Hospital in Pennsylvania received a C on the Spring 2016 Leapfrog Hospital Safety Grade, leaders launched a campaign to improve patient safety. A central tactic was adapting its staffing model to meet Leapfrog’s ICU Physician Staffing criteria.1
Less than a year later, the hospital improved its safety grade to an A. The hospital has now earned an A for eight consecutive periods.
Leapfrog’s standard requires that all critical care patients in the ICU be managed or co-managed by physicians who are board-certified in critical care medicine and who are present in the ICU at least eight hours a day, seven days a week. They also must respond to 95% of texts or calls within five minutes.
Previously, the hospital restricted what physicians could practice in the ICU and offered no formal intensivist program, says Scott Levy, MD, vice president and chief medical officer of Doylestown Health. With the effort to improve the Leapfrog score, hospital leaders committed to developing an intensivist program.
Levy thought the existing coverage only needed to be formalized, but he found a specific intensivist program brought benefits.
“The place to find our intensivists was easy because we already had an extremely strong group of physicians here. All of them [were] board-certified pulmonary doctors and intensivists who were doing that kind of work without the formal program in place and the official man-hours covered,” Levy explains. “They were covering what was needed, but without the hours required for a formal program that Leapfrog would recognize. I was not expecting a lot of cultural change, but the intensivist program brought multidisciplinary rounds, teaching, and an enthusiasm that was really shocking.”
The program now includes five intensivists who rotate through the unit, says Les Szekely, MD, intensivist and pulmonologist. The day’s first intensivist usually arrives around 6 a.m. and relieves the nighttime intensivist, conducting multidisciplinary rounds at 9 a.m., Szekely says. The rounds may last two hours, depending on the patients. Such rounds are used as educational opportunities for all the disciplines involved with the ICU, Szekely says. That may include pharmacists, nutritionists, physical therapists, nurses and nurse managers, and respiratory therapists.
“We have people watch for Foleys, pneumonias, DVT prophylaxis, lots of things. We involve patients’ family members also,” Szekely says. “We’ve seen significant improvements in patient satisfaction and workforce satisfaction because it is a collaborative effort with each patient. The staff are happy, and the patients are happy.”
Data Show Improvements
Over a four-year period, ICU admissions increased significantly through 2018 and then leveled off again in 2020, with most metrics remaining the same. The average DRG weight went from 2.25 in 2016 to 2.39 in 2020. The average ICU length of stay went from 2.67 days in 2016 to 1.75 days in 2020. The average ventilator days decreased from 4.43 days in 2016 to 3.62 days in 2020. (Based on fiscal year 2020 data collected between July 1, 2019 and June 30, 2020.)
The biggest challenge has been recruiting intensivists for night shifts, Szekely says. Levy notes there also is a cost to keeping the ICU fully staffed with intensivists even when it is relatively quiet. Nevertheless, the hospital has decided the benefits outweigh the financial commitment. “We’re very proud of the program. It’s been tremendously successful,” Szekely offers. “I think it’s the standard of care now. Anyone who does short of that is shortchanging their community to some degree. You can still provide good care, but this brings it to a new level.”
- Leapfrog Hospital Survey. Factsheet: ICU physician staffing. Last revised April 1, 2020.
- Scott Levy, MD, Vice President, Chief Medical Officer, Doylestown Health, Doylestown, PA. Phone: (215) 345-2200.
- Les Szekely, MD, Intensivist, Pulmonologist, Doylestown Health. Phone: (215) 345-2200.