There are approximately 75,000 ICU beds nationwide, with an average daily census between 45,000 and 50,000. Moreover, about 5 million patients are cared for in the nation's ICUs each year, and these patients represent 25 percent of the cost structure for most hospitals. That ICU population is predicted to double over the next 15 years as the population ages, making the ICU an important growth area for hospitals.

Patients in the ICU are often sicker than those in other areas of the hospital, and they are among the costliest to care for. Although many hospitals have saved lives and lowered costs by focusing on high cost, high risk service lines like cardiology and orthopedics, few have focused such attention on the ICU. Because of the diversity of illness encountered in the ICU and the critical nature of many ICU patients, many health care managers and clinicians have avoided this area as simply too complex to attempt full scale performance improvement studies.

By identifying the 100 Top Hospitals: ICU Benchmarks for Success award winners, we are taking the first step in addressing variances in ICU treatment outcomes and costs throughout the nation. There is a marked difference between these top-performing hospitals and their peers. To summarize:

• 100 Top Hospitals have better clinical outcomes—in terms of mortality and complications—for ICU patients than do other hospitals. This is true for even the sickest ICU patients. 
• ICUs at 100 Top Hospitals use their resources more efficiently than do other hospitals. 
• ICU patients at 100 Top Hospitals spend less total time at the hospital than do ICU patients at other acute care hospitals.

This study shows that under-performers can make changes to actually increase the health and survival rates of their ICU patients, and these changes can be made without sacrificing cost controls. While this study identifies leaders in ICU outcomes, this is only a first step. The leaders identified here likely have multiple ICUs—with differing processes and policies—staffed and supervised by personnel from a myriad of clinical disciplines. Any attempt to truly emulate their lead would require studying their care processes and policies in detail. Both Solucient and VISICU are committed to aiding hospitals in this endeavor.