SCCM - Society of Critical Care Medicine

The 2012 Statistics Brochure

View the Statistics Brochure pdf

The Society of Critical Care Medicine (SCCM) represents nearly 16,000 highly trained professionals in more than 100 countries who provide care in specialized units and work toward the best outcome possible for all critically ill and injured patients. The Society maintains that the Right Care, Right Now™ is best provided by an integrated team of dedicated experts directed by a trained and present physician credentialed in critical care medicine (an intensivist), also referred to as the multiprofessional team model. Care delivered by a multiprofessional team optimizes care for patients, improves conditions for healthcare providers, and boosts the financial performance of the hospital. This guide provides statistics on many of the current issues in critical care in the United States. It is intended to be used as a reference in efforts such as advocacy, public relations, and general education.

Cost Savings

Between 2000 and 2005, annual critical care medicine costs increased from $56.6 to $81.7 billion, representing 13.4% of hospital costs, 4.1% of national health expenditures, and 0.66% of gross domestic product. Cost savings up to $1 billion per quality-adjusted life year can be attained with critical care management of severe sepsis, acute respiratory failure, and general critical care interventions. Twenty-four–hour intensivist staffing reduces ICU costs and length of stay. Up to $13 million in annual hospital cost savings can be realized when care is delivered by an intensivist-directed multiprofessional team.

Sources:

■ Halpern NA, Pastores SM. Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010;38:65-71.

■ Talmor D, Shapiro N, Greenberg D, et al. When is critical care medicine cost-effective? A systematic review of the cost-effectiveness literature. Crit Care Med. 2006;34:2738-2747.

■ Banergee R, Naessens JM, Seferian EG, et al. Economic implications of nighttime attending intensivist coverage in a medical intensive care unit. Crit Care Med. 2011;39:1257-1262.

■ Pronovost PJ, Needham DM, Waters H, et.al. Intensive care unit physician staffing: financial modeling of the Leapfrog standard. Crit Care Med. 2004; 32:1247-1253.

Critical Care Patients

More than 5 million patients are admitted annually to ICUs in the United States. The five primary ICU admission diagnoses are, in decreasing order: respiratory insufficiency/failure, postoperative management, ischemic heart disorder, sepsis, and heart failure. Since 1991, treatment of many serious conditions has become more frequent, including gastrointestinal hemorrhage, hemodynamic abnormalities, multiple organ system failure, respiratory insufficiency or failure, sepsis, and shock. This can be attributed in part to the aging US population: the mean age is rising and the number of individuals aged 65 years and older is increasing, primarily due to the baby boom generation. Also evident is the dramatic rise in patients 85 years and older, from 4.1% in 1991 to 6.9% in 2004. Between 2000 and 2020, the population younger than 65 years is expected to grow by about 10%, while the number of individuals 65 years and older is projected to rise by approximately 50%. ICU patients are a heterogenous population, but all share the need for a higher level of acute care than most hospitalized patients. Frequently, patients in the ICU require ventilatory or cardiovascular support, invasive monitoring, and intensive observation by nursing and physician staff members. With a greater reliance on technology to keep critically ill patients alive (i.e., mechanical ventilation, hemodialysis, plasmapheresis, extracorporeal membrane oxygenation), the number of ICU beds has grown dramatically in the United States, with the current estimate being >6,000. In 2000, children and adolescents accounted for 6.3 million hospital tays (18%). Five of the 10 most common diagnoses for neonates are for either respiratory problems or infections: immunizations and screening for infections; other conditions occurring around the time of birth; hemolytic jaundice and perinatal jaundice infant jaundice following birth); premature birth and low birth weight; medical examination/evaluation; fluid and electrolyte disorders (primarily dehydration and fluid overload); asthma; residual codes, unclassified; other birth defects.

Sources:

■ Angus DC, Kelly MA, Schmitz RJ, et al, for the Committee on Manpower for Pulmonary and Critical Care Societies. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA. 2000;284:2762-2770.

■ Joint Commission Resources. Improving Care in the ICU. 1st ed.. Oakbrook Terrace, IL: Joint Commission Resources; 2004.

■ Rosenbaum SH, Thompson DR, eds. Organizational and management ethics in the intensive care unit. Crit Care Med. 2007;35(Suppl.):S1-S121.

■ Society of Critical Care Medicine. Critical Care Units: A Descriptive Analysis. 1st ed. Des Plaines, IL: Society of Critical Care Medicine; 2005.

■ US Department of Health and Human Services, Health Resources and Services Administration Report to Congress. The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians. May 2006. Available at http://bhpr.hrsa.gov/healthworkforce/reports/studycriticalcarephys.pdf. Accessed January 4, 2012.

■ US Department of Health and Human Services, Agency for Healthcare Research and Quality. National estimates on use of hospitals by children from the HCUP Kids’ Inpatient Database (KID). Rockville, MD: Agency for Healthcare Research and Quality; 2009.

ICU Facilities

The United States has 5,795 hospitals according to the American Hospital Statistics 2009 survey data, comprising a total of 944,277 staffed beds. All acute care hospitals have at least one ICU, and approximately 55,000 critically ill patients are cared or each day. In 2007, the number of adult critical care beds (medical, surgical, coronary care, neurological, and burn unit beds) totaled 67,357. Additionally, the United States has 337 pediatric intensive care units with approximately 4,044 beds, and over 1,500 neonatal intensive care units with approximately 20,000 beds.

Sources:

■ Carr BG, Addyson DK, Kahn JM. Variation in critical care beds per capita in the United States: Implications for pandemic and disaster planning. JAMA. 2010;303:1371-1372.

■ Halpern NA, Pastores SM. Critical care medicine in the United States 2000-2005: an analysis of bed numbers, occupancy rates, payer mix and costs. Crit Care Med. 2010;38:65-71.

■ Health Forum, LLC. American Hospital Association Hospital Statistics, 2011 (2009 survey data). Chicago, IL: American Hospital Association; 2011.

■ Odetola FO, Clark SJ, Freed GL, Bratton SL, Davis MM. A national survey of pediatric critical care resources in the United States. Pediatrics. 2005;115:e382-e386.

Length of Stay

Intensivist-directed care can lead to a significant reduction in ICU length of stay. Studies indicate a stay averages 6.1 days when care is provided by an intensivist versus 9.3 days when care is provided by an attending physician. This finding is consistent in medical and surgical ICUs where reductions range from 11% to 30%. In addition, TeleICU coverage also demonstrates a benefit, reducing length of stay by almost 1.5 days.

Sources:

■ Combs AH, Rainey TG. Making the business case. Critical Care Summit: ICU Quality and Cost. Des Plaines, IL: Society of Critical Care Medicine; 2003.

■ Lee JC, Rogers FB, Horst MA. Application of a trauma intensivist model to a level II community hospital trauma program improves intensive care unit throughput. J Trauma. 2010;69:1147-1153.

■ Mains C, Scarborough K, Bar-Or R, et al. Staff commitment to trauma care improves mortality and length of stay at a level I trauma center. J Trauma. 2009;66:1315-1320.

■ Young LB, Chan PS, Lu X, et al. Impact of telemedicine intensive care unit coverage on patient outcomes: a systematic review of meta-analysis. Arch Intern Med. 2011;171: 498-506.

Morbidity and Mortality

Although patients in intensive care units (ICUs) receive care for a large variety of disease states, the leading causes of death in the ICU are multiorgan failure, cardiovascular failure, and sepsis. Multiorgan failure has a mortality rate of 11% to 18%. Sepsis, the second leading cause of death in noncoronary ICUs, carries a mortality rate of 25% to 30%. Of patients who are diagnosed with sepsis, up to 51% will develop acute renal failure, up to 18% will have acute respiratory failure, and up to 80% will develop a myopathy or polyneuropathy. Overall mortality rates in patients admitted to adult ICUs average 10% to 29%. Recent studies have shown that the pediatric mortality rate associated with sepsis is 13.5%, whereas the overall mortality rate for pediatric ICU patients ranges from 2% to 6%. A mortality rate of 6.04% has been reported in ICUs with intensivist staffing compared with 14.4% when a non-intensivist attending provides care.

Sources:

■ Kutco MC, Calarco MP, Flaherty MB, et al. Mortality rates in pediatric septic shock with and without multiple organ system failure. Pediatr Crit Care Med. 2003;4:333-337.

■ Joint Commission Resources. Improving Care in the ICU. 1st ed. Oakbrook Terrace, IL: Joint Commission Resources; 2004.

■ Mayr VD, Dünser MW, Greil V, et al. Causes of death and determinants of outcome in critically ill patients. Crit Care. 2006;10:R154.

■ Pronovost PJ, Needham DM, Waters H, et al. Intensive care unit physician staffing: financial modeling of the Leapfrog standard. Crit Care Med. 2004;32:1247-1253.

■ Wang HE, Devereaux RS, Yealy DM, Safford DM, Howard G. National variation in United States sepsis mortality: a descriptive study. Int J Health Geogr. 2010;9:9.

Staffing/Salary

Patient care in the ICU is best provided by an integrated team of dedicated experts directed by a trained and present physician credentialed in critical care medicine (an intensivist). The team may consist of critical care nurses, intensivists, nurse practitioners, pharmacists, physician assistants, physician specialists, primary care physicians, respiratory therapists, other professionals, and patients and their families. Nearly 10,360 intensivists and 503,124 critical care nurses practice in the United States. The average base salaries for members of the multiprofessional team are: critical care staff physician, $261,383; critical care staff nurse, $74,330; critical care nurse practitioner, $100,406; staff critical care respiratory therapist, $56,1821; and critical care clinical pharmacist, $108,960.

Sources:

■ American Association of Critical-Care Nurses, American College of Chest Physicians, American Thoracic Society and Society of Critical Care Medicine. The aging of the U.S. population and increased need for critical care services. Critical Care Workforce Partnership Position Statement. November 2001. Available at: http://www.chestnet.org/downloads/practice/gr/HRSABackgrounder. pdf. Accessed January 5, 2012.

■ Joint Commission Resources. Improving Care in the ICU. 1st ed. Oakbrook Terrace, IL: Joint Commission Resources; 2004.

■ Society of Critical Care Medicine. Compensation of Critical Care Professionals. 2nd ed. Mount Prospect, IL: Society of Critical Care Medicine; 2008.

Work Force Shortage

The increase in patient demand for critical care services, caused by the aging population and advances in medicine that extend life expectancy, has put a tremendous strain on critical care. Although a 5.2% increase in fellows in critical care subspecialty programs occurred between 2003/2004 and 2004/2005, signifying that the number of physicians entering critical care is growing, the long-standing shortage of nurses, clinical pharmacists, and respiratory therapists will make it difficult to meet patient demand. Research indicates that the demand will create a shortfall of intensivist hours equal to 35% of demand by 2020. The Society of Critical Care Medicine is a member of the Critical Care Societies Collaborative (CCSC), which is working to propose solutions to alleviate the workforce shortage in the U.S. healthcare system. The CCSC is an alliance of four medical societies who represent more than 100,000 members integral to critical care delivery: the American Association of Critical-Care Nurses (AACN), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and the Society of Critical Care Medicine (SCCM). The website for the CCS is http://ccsconline.org.

Sources:

■ Acute Care Hospital Survey of RN Vacancy and Turnover Rates in 2000. Washington, DC: American Organization of Nurse Executives; January 2002.

■ Angus DC, Kelly MA, Schmitz RJ, White A, Popovich J, Committee on Manpower for Pulmonary and Critical Care Societies. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA. 2000;284:2762-2770.

■ Brotherton SE, Rockey PH., Etzel SI. U.S. Graduate Medical Education, 2004-2005: Trends in Primary Care Specialties.” JAMA. 2005;294:1075-1082.

■ ICU staffing shortages linked to aging population. ATS Bulletin. December 1, 2011. Available at: http://ats-365.ascendeventmedia.com/highlight.aspx?id=1135&p=45. Accessed January 5, 2012.

■ Isgur B. Healing the health care staffing shortage. Health Forum Trustee Magazine. February 2008. Available at: http://www.trusteemag.com/trusteemag_app/jsp/articledisplay. jsp?dcrpath=TRUSTEEMAG/Article/data/02FEB2008/0802TRU_FEA_Healing&domain=TRUSTEEMAG. Accessed January 5, 2012.

■ Joint Commission Resources. Improving Care in the ICU. 1st ed. Oakbrook Terrace, IL: Joint Commission Resources; 2004.