Outcomes in Critical Care Medicine

Abstract

As the costs of health care have risen, attention has focused on the analysis of the quality and outcomes of health care. In this issue ofTHE JOURNAL, Reynolds et al1evaluated the effects of changing the physician staffing in a medical intensive care unit (MICU) so that the staff consisted of dedicated critical care medicine (CCM) staff physicians and postresidency trainees in critical care. The impact of these changes on treatment patterns, morbidity and mortality, and hospital charges of patients with a single disease entity (septic shock) was studied during two periods. Two groups of patients were compared: those treated by faculty without CCM training who supervised the MICU and patients treated by physicians formally trained in CCM and postresidency CCM fellows. Mortality was lower during the post-CCM period (74% vs 57%). The authors concluded that the implementation of dedicated staffing by CCM physicians in a university hospital