Impact of increased numbers of intensive care consultants on outcome in a central London teaching hospital

Introduction

The standardised mortality ratio (SMR) is a key parameter by which ICUs quantify their performance. We report the effect of increased ICU consultant numbers on mortality and SMR in a central London teaching hospital.

Methods

The study was registered with the Clinical Audit Support System. Data were collected prospectively from March 2005 to date by a dedicated audit team and were analysed as part of routine audit.

Results

Table 1 shows the reduction in mortality and SMR from 2005 to date, comparing these data with patient and consultant numbers.

Table 1 SMR and mortality reduction from 2005 to date

Conclusions

In this study we describe the remarkable reduction in both mortality and SMR that has occurred in the general ICU at King's College Hospital over the past 5 years. The improvement in outcomes was associated with a quadrupling of ICU consultant numbers. We hypothesize that this increase in intensivist numbers allowed the reinforcement of a closed model of ICU care. We are now further analysing these data to search for quantitative improvements in surrogate markers of quality of care over the same time frame.