In the United States, ICU (intensive care unit) mortality rates vary from 8% to 25% for various reasons.1 such as patient demographics and facility location. These numbers highlight an important issue – the survival rate of ICU patients depends on where and how they are treated.
ICU doctors, or intensivists, are on the front lines of these life-and-death situations. Knowledge of advanced life support techniques and advanced medical technology is essential to patient survival. For example, early management of movement therapy2 It is crucial to improve the rate of recovery.
But how can patients evaluate the skills of their doctors in a hospital? Dr. Pierre Cory used this hypothesis as a guide to conduct research to ensure that patients receive the best possible care.
Assessing the life-saving skills of ICU doctors – a new perspective
In Corey’s research posted on the Substack page,3 He explains that doctors should be given the same status as NFL (National Football League) quarterbacks. Just as these athletes are judged on their performance by certain criteria, Corey developed a method to evaluate the life-saving skills of ICU specialists. For background, “best doctors” are routinely measured by what they call imperfect metrics, such as:
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reputation – Word of mouth recommendations, which medical school you came from and number of years in practice |
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Verification – A doctor has various certificates, etc. |
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Error history: If you are sued by a former patient |
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Stages of post-wound infection – As Cory says, “That’s probably the only real statistical measure you can judge doctors on.” |
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Patient Complaints- How many patients complained about a doctor |
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Geography and Insurance/Schedule Availability – Some patients choose the most convenient option for them |
To create an objective method for evaluating doctors, Corio’s study used the APACHE (Acute Physiology, Age, Chronic Health Evaluation) score, which is the most effective predictor of patient mortality.
The causes of turnover in the skills of ICU doctors are multifaceted. Factors such as the ability to make early and accurate diagnoses, reliance on bedside diagnostic skills, and the use of advanced techniques such as ultrasound play a significant role. For example, Corey’s expertise in ultrasound allowed him to minimize the need for further tests. This approach not only saves resources but also reduces wasted time, which is important when caring for ICU patients.
It is important to understand how these factors contribute to patient outcomes. When doctors rely on extensive testing, this may indicate uncertainty or lack of confidence in their diagnostic skills. In contrast, those who use fewer resources, such as Corey, often exhibit higher levels of knowledge and efficiency. This is key to improving survival rates as timely and accurate interventions are essential in critical care settings.
A revolutionary way to analyze the performance of the ICU doctor
Before going any further, note that Corey’s research is a personal investigation published on his subpage. The reason he didn’t publish this in a medical journal was fear of creating “discord and controversy (and maybe even embarrassment)” among the ICU team he was in charge of at the time. After getting the background, he noticed a remarkable change in the ability of ICU doctors to save lives.4
The study focused on patients previously admitted to the ICU under the supervision of this team of doctors led by Corey. By closely monitoring how each physician uses diagnostic tests and interventions, the study revealed significant differences in their approach and effectiveness.5
Again, Corey, being a big football fan, envisioned a system where doctors would be evaluated similar to NFL quarterbacks, with each clinic assigning a ‘Quarterback Rating’ (QBR) based on their performance.6 This comparison highlights the significant differences in skill levels between ICU specialists.
Ignoring the six “traditional” parameters used to evaluate doctors, Corey uses the APACHE score to predict a patient’s risk of death based on various health indicators.7
By calculating the observed patient mortality rate for each physician and comparing it to the expected rate, Corey developed an observed/expected (O/E) mortality ratio.8 Basically, a lower O/E ratio indicates a better skilled ICU doctor, while a higher ratio indicates poorer performance.9
Corey realized that many of his colleagues were overusing interventions such as invasive catheters, leading to unnecessary procedures that did not improve patient outcomes.10 This excessive use of resources not only increases costs but also shows a lack of confidence in diagnostic capabilities.11
To do the statistical analysis, Corey used advanced software called QlikView, which allowed each doctor to evaluate the number of tests ordered and the time he consulted with other specialists.12 This data-driven approach showed a big picture of each doctor’s skills, which showed a significant difference in their practice.13
Ultimately, Corey’s goal is to challenge the status quo by advocating a shift toward metrics that truly reflect clinical performance and patient outcomes. Such changes lead to better care and better outcomes for patients.14
Effects of differences in ICU resource utilization on patient survival
The study focused on 17 ICU doctors, each of whom was represented by letter of anonymity. Over an 18-month period, each doctor managed an average of 130 patients. The study was designed to understand whether the frequency of testing and consultation affected patients’ chances of being discharged from the ICU alive. The results are shown in the table below:
The findings revealed a shocking disparity in resource use. For example, Dr. G ordered 19 times more tests than the least active doctor, Dr. E (Corey), who was the least active in ordering CT scans.15 Interestingly, this higher resource utilization did not correlate with better patient outcomes. In fact, Doctor 1, who ordered twice as many chest CT scans as the next-level doctor, had the lowest rate of getting patients out of the ICU alive.16
In contrast, doctors who followed a more minimal approach, using fewer tests and relying on bedside tests such as ultrasound, saw better patient survival rates.17 These doctors are able to start the correct treatment methods early in the course of the disease, which directly has a positive effect on the patient’s recovery. For example, Dr. C, the most resource-intensive doctor, used approximately twice as many resources as Dr. E, but the results did not favor high resource use.18
“Minimalist” doctors, in Corey’s terms, were rated higher for their conservative approach, and had better outcomes in saving lives. In other words, higher testing rates do not equal better care. Conversely, efficient use of resources, focusing on important diagnoses, increases patient survival. For overall results, see the table below:
As shown in the image above, a minimal approach to resource utilization in the ICU, with fewer diagnostic tests and consultation between specialists, leads to better patient outcomes. Excessive use of medical resources does not increase the rate of recovery and in some cases can hinder timely and effective treatment. According to Corey, contributing factors include increased radiation exposure to the patient, as well as the risks of transportation on the hospital premises.
Practical steps to help you stay healthy in a hospital setting
While it may not be practical to ask for the best doctors in a hospital, there are still ways to manage your health in a clinic or inpatient setting to reduce the resources used (and thus, the financial costs). By actively participating in your health decisions, you are empowering yourself to advocate for the treatments that are best for your health. Some of my tips include:
1. Choose healthcare providers who listen and embrace a holistic approach – If you are seeking medical care, make it a priority to find health care professionals who listen carefully to your concerns and consider the overall picture of your health.
A doctor who takes a holistic view evaluates all aspects of your well-being rather than focusing on isolated symptoms or conditions. They also develop customized, comprehensive treatment plans. This holistic approach leads to more accurate diagnoses and effective treatment plans based on your current health profile.
2. Create a “Caregivers and Consent” document – I strongly recommend that you prepare a “Caregivers and Consent” document to clearly outline your health care choices and decisions. This document serves as a guide for your medical team and loved ones, making sure your wishes are respected, especially during difficult times.
The templates for this document were created by Laura Bartlett and Greta Crawford of ProtocolKills.com. They developed the documents in response to patient abuse during the Covid-19 pandemic. Having this document in place provides peace of mind and clarity in high pressure situations. The template is available on the Patient Documents page. Other documents are available for medical power of attorney.19
3. Take an active role in managing your health: Being aware of your health and actively participating in your treatment can have a significant impact on your outcomes. Monitor your health biomarkers regularly, ask your doctor questions, and stay committed to your treatment plan. By doing so, it allows you to effectively collaborate with your healthcare providers and adjust your approach as needed to ensure optimal recovery.
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