Intensivist-to-bed ratio - Association with outcomes in the medical ICU

Objective: With an increasing number of critical care beds, a shortage of critical care physicians, and pressure from purchasers, there is a need to define the optimal intensivist-to-ICU bed ratio. The objective of this study was to determine if there are any associations between the intensivist-to-ICU bed ratio and the outcome of patients admitted to the medical ICU. Design: Retrospective cohort study. Setting: A tertiary care medical center. Patients: All critically ill patients admitted to a medical ICU between December 8, 2001, and July 14,2003. Interventions: None. Measurements: Demographics, APACHE (acute physiology and chronic health evaluation) III-predicted mortality, ICU length of stay (LOS), hospital LOS, and ICU and hospital mortality rates. Four time periods based on intensivist-to-ICU bed ratios of 1;7.5, 1:9.5, 1:12, and 1:15 were identified. Regression analyses were performed to develop customized models to predict ICU and hospital LOS and mortality. The ICU LOS ratio, defined as the ratio of the observed to predicted LOS, and standardized mortality ratio (SMR) were calculated for each of the four periods. Results: A total of 2,492 patients were included in the study. There was no difference in the severity of illness at the time of ICU admission among the four periods. The mean ICU LOS ratio was longer for an intensivist-to-ICU bed ratio of 1: 15 compared to the other periods. The ICU and hospital STMR did not differ significantly among the four periods. Conclusion: Differences in intensivist-to-ICU bed ratios, ranging from 1:7.5 to 1:15, were not associated with differences in ICU or hospital mortality. However, a ratio of 1:15 was associated with increased ICU LOS.