Health Care Costs and Financing

24-hour intensivist care in ICUs can lead to cost savings for the sickest patients admitted at night

Health care organizations such as the Society for Critical Care Medicine recommend that level-1 intensive care units (ICUs) be staffed with 24-hour in-house intensivists. Others, such as The Leapfrog Group, a consortium of major health care providers, recommend an on-demand care model in which intensivists are present during day hours (7AM to 7PM) and available by page at other times. Because the first few hours of intensive care are the most critical for many patients, the 24-hour model could particularly benefit the sickest patients admitted to the ICU at night. That's exactly what a new study found.

Researchers assessed the cost implications of substituting the 24-hour intensivist model for the on-demand model of intensivist care. The costs for the 24-hour intensivist model were 61 percent lower for the sickest patients admitted during night hours (7PM to 7AM). The finding of lower costs for the sickest patients when treated by 24-hour intensivists is consistent with these researchers' earlier findings of decreased ICU and total length of hospital stay for patients treated under the same model.

Among less-ill patients admitted at night or among patients admitted during the day, there were no significant changes in costs. The cost savings observed by the researchers of somewhat more than $10,000 per patient among the sickest patients admitted at night suggest the potential for large savings for specific patients that are big enough to make this economically attractive for quite small ICUs. The study included patients admitted to the adult medical ICU at a large academic hospital during 2005-2006. The sickest patients were those who were in the highest 25 percent as measured by the Acute Physiology and Chronic Health Evaluation III instrument. This study was supported in part by the Agency for Healthcare Research and Quality (HS16967).

See "Economic implications of nighttime attending intensivists coverage in a medical intensive care unit," by Ritesh Banerjee, Ph.D., James M. Naessens, Sc.D., Edward G. Seferian, M.D., and others in Critical Care Medicine 39(6), pp. 1257-1262, 2011.

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