Barriers to implementing the Leapfrog Group recommendations for intensivist physician staffing: a survey of intensive care unit directors

Jeremy M Kahn, Francesca A Matthews, Derek C Angus, Amber E Barnato, Gordon D Rubenfeld
Journal of Critical Care 2007, 22 (2): 97-103

PURPOSE: The Leapfrog Group, representing a consortium of health care purchasers, has promoted standards for intensive care unit (ICU) staffing in nonrural areas. The purpose of this study was to examine the perception of the Leapfrog standards among ICU directors and determine the potential barriers to implementing these standards.

MATERIALS AND METHODS: We performed a telephone survey of physician ICU directors using a stratified random sample of hospitals in the Committee on Manpower for Pulmonary Critical Care Societies database.

RESULTS: Seventy-two ICUs in 72 hospitals were surveyed. Forty-seven ICUs responded to telephone inquires. Of these, 21 (45%) could identify an ICU director, 20 of which answered questions about their own hospital's compliance. Only 5 ICU directors (25%) cited current compliance with the Leapfrog standard for intensivist staffing. Of the 15 directors not in compliance, 13 were motivated to adopt the recommendations in the future. Loss of control, loss of income, and increased cost to hospital administration were cited as important barriers to implementing the recommendations. Increased availability of intensivists, increased funds from hospital administrators, and assistance from government and third parties were viewed as important potential solutions to these barriers.

CONCLUSIONS: Numerous barriers exist to implementing the Leapfrog recommendations for intensivist staffing, not the least of which is the lack of an ICU director in many hospitals. Better strategies are needed to overcome these barriers before the widespread adoption of an intensivist care model similar to Leapfrog is feasible.

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