Patients in an intensive care unit whose care is managed by "intensivists"--physicians specially trained in critical care medicine--have a greater chance of survival and a shorter hospitalization, according to researchers at Johns Hopkins and the University of Pittsburgh.

Results of the study, published in the Nov. 6 issue of the Journal of the American Medical Association, showed that having such intensive care experts could reduce death rates by 30 percent, compared to prior estimates of a 10 percent reduction. This increases the number of potential lives saved each year from 54,000 to 162,000, says Peter J. Pronovost, lead author of the study and associate professor of anesthesiology and critical care medicine at Johns Hopkins.

"The magnitude of intensivists is as big as the best therapies we have, yet the opportunity to improve care with intensivists is invisible to most patients and providers," Pronovost says. "This should be a huge focus for improving the quality of care in this country, especially since only 10 percent of hospitals employ these specialists."

For the study, researchers searched medical literature for studies comparing physician management in the intensive care setting. They culled 2,590 abstracts and 26 observational studies, giving them 27 comparisons of alternative staffing strategies for ICUs. Patients at hospitals that had a higher concentration of critical care specialists had reduced ICU and hospital death rates and lengths of stay.

The approximately 6,000 ICUs in this country care for about 55,000 patients a day, at a budget of $180 billion.