Hospital Referral Guidelines

Michigan Health and Safety Coalition Hospital Referral Guideline for Intensive Care Unit Physician Staffing*

• For adult Intensive Care Units (ICUs), hospitals should operate "closed" ICUs that meet the following criteria:

1. The adult ICU is managed by an intensivist; i.e., a physician certified (or eligible for certification) in critical care medicine who directs clinical care for the ICU where:
   • concurrent care by the primary attending, surgical or medical, is encouraged for all patients; and
   • admission and discharge criteria, and implementation of care protocols should be monitored by the intensivist.
2. The intensivist will be present during daytime hours (8am to 5pm), without conflicting responsibilities; and at other times, the intensivist is immediately available to the ICU by phone or pager, in other words, returns 95% of ICU pages within 5 minutes; and arranges for an appropriately qualified physician or physician extender to be physically present in the ICU within 5 minutes 95% of the time. An appropriately qualified physician extender has FCCS certification and meets the competencies established by the credentialing committee of each hospital.

Future direction of Coalition work related to the ICU Physician Staffing Guideline

Convene a panel under the auspices of the Michigan Health and Safety Coalition to address ICU quality of care risk-adjusted outcomes and structural characteristics including non-physician staffing levels and access to ancillary services including unit clerks/secretaries, transportation, and other support personnel. In addition, have the panel review and consider integrating ICU staffing guidelines as developed by the Society of Critical Care Medicine and the Advisory Board Company. Consider staffing recommendations in light of the differences and variability in hospitals, ICUs, and types of patients admitted to ICUs.

* This is meant to be a guideline and not a standard of care; this guideline represents the best of an evidence-based review at this time; the guideline is based on the principles of CQI and is not intended to be used in a punitive manner; this guideline needs to be taken as a whole, and not have selected parts be used without considering the entire content of the guideline.