Influence of a Multidisciplinary Alert Strategy on Mortality Due to Left-sided Infective Endocarditis

Carrasco-Chinchilla, Fernando; Sánchez-Espín, Gemma; Ruíz-Morales, Josefa; Rodríguez–Bailón, Isabel; Melero-Tejedor, José María; Ivanova-Georgieva, Radka; García–López, Victoria; Muñoz-García, Antonio J.; Gómez‐Doblas, Juan José; Teresa–Galván, Eduardo de

doi:10.1016/j.rec.2013.09.010

Cited by 13 publications

(20 citation statements)

References 35 publications

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“…Three prior studies have evaluated multidisciplinary approaches to the management of infective endocarditis, and all found significant reductions in hospital mortality after implementation: 12.7% to 4.4% [ 19 ]; 28% to 13% [ 20 ]; and 36.1% to 16.7% [ 21 ]. Two studies developed and adhered to standardized medical and surgical protocols that were uniformly applied to all patients [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Two studies developed and adhered to standardized medical and surgical protocols that were uniformly applied to all patients [ 19 , 20 ]. In the other study, members of the multidisciplinary collaboration were the attending physicians directly responsible for the patients’ care [ 21 ]. These studies also showed dramatic improvements in medical management, such as greater appropriateness of antimicrobial agent and duration (61.8% [post-intervention] vs. 22.7% [pre-intervention]) [ 19 ], as well as earlier diagnosis, greater use of transesophageal echocardiography, and a microbiological alert system that accelerated initiation of appropriate antimicrobial therapy [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recent guidelines by the European Society of Cardiology, American College of Cardiology and American Heart Association have recommended a collaborative approach to the management of infective endocarditis [ 1 , 2 ], with involvement of a multidisciplinary team including cardiac surgeons, cardiologists, infectious diseases physicians, neurologists and other specialists to optimize decision-making. Three European centres that implemented a team-based model for managing infective endocarditis demonstrated significant reductions in mortality [ 19 – 21 ]. However, such approaches have not been evaluated in a North American context.…”

Section: Introductionmentioning

confidence: 99%

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Case conferences for infective endocarditis: A quality improvement initiative

et al. 2018

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BackgroundA multidisciplinary approach has been recommended for the management of patients with infective endocarditis. We evaluated the impact of multidisciplinary case conferences on morbidity, mortality, and quality of care for these patients.MethodsWe conducted a quasi-experimental study of consecutive patients admitted for infective endocarditis before (2013/10/1–2015/10/12, n = 97) and after (2015/10/13–2017/11/30, n = 80) implementation of case conferences to discuss medical and surgical management. These occurred as face-to-face discussions or electronically (for non-complex patients), and included physicians from cardiac surgery, cardiology, critical care, infectious diseases and neurology. We assessed process-of-care and clinical outcomes, with the primary outcome being complications up to 90 days after hospital discharge.ResultsA case conference was held for 80/80 (100%) of patients in the post-intervention group. After the intervention, more patients received inpatient cardiology assessment (81.3% [post-intervention] vs. 63.9% [pre-intervention], p = 0.01), and more patients with definite infective endocarditis underwent cardiac surgery treatment (44.6% vs. 21.7%, p = 0.007). All pre-intervention and post-intervention patients received guideline-concordant antimicrobial therapy. There was no difference in rates of complications (40.0% vs. 51.5%, p = 0.13) or mortality up to 90 days after hospital discharge (26.3% vs. 17.5%, p = 0.20). In multivariable analyses, the intervention was not associated with differences in mortality (odds ratio 1.87, 95% confidence interval 0.88–3.99) or a composite measure of complications and mortality (odds ratio 0.86, 95% confidence interval 0.46–1.58).ConclusionWe successfully implemented a standardized multidisciplinary case conference protocol for patients with infective endocarditis. This intervention had no detectable effect on complications or mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case conferences for infective endocarditis: A quality improvement initiative

et al. 2018

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“…1). This round table approach has been shown to significantly reduce the in-hospital and 1-and 3-year mortality in France, Italy and Spain [4][5][6]. To be effective, the structure of an E-Team has to be modelled, taking specifications of health systems, including cultural and socio-economics, in consideration.…”

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The round table approach in infective endocarditis & cardiovascular implantable electronic devices infections: make your e-Team come true

Erba

Habib

Glaudemans

et al. 2017

Eur J Nucl Med Mol Imaging

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Over the past decade health care systems have faced a set of challenges leading to an increasing emphasis on interdisciplinary team work. Workforce re-structuring is the result of several factors including population changes and growth in medical knowledge with the consequent increasing rate of specialization. Aging of the population, the increasing numbers of patients with more complex needs, associated with chronic diseases, has increased tremendously. On the other side, increasing specialization within health professions have led to fragmentation of disciplinary knowledge resulting in no one health care professional being able to meet all the complex needs of their patients. Multidisciplinary team working has been proposed as the model for several years in oncology in many hospitals and medical centres. More recently, the multidisciplinary team approach has been extended in patient management as a response to manage complex disease states, beyond oncology. In the Cardiology field, the transcatheter aortic valve implantation (TAVI) team is a recent example [1]. In the field of infective endocarditis (IE), in some centers a multidisciplinary approach for evaluating patients with IE is

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“…9 Dedicated endocarditis teams have worked on this for a long time and have demonstrated the benefits of this collective behavior reducing in-hospital and 1-and 3-year mortality in several European countries. [10][11][12] Within the discussion of strategies for stroke management, the review by Yanagawa and colleagues 5 highlights the contribution of the Barcelona Working Group on Endocarditis that has focused on collaborative work for over three decades. 13 The Barcelona Endocarditis Team model resulted in a common language used by specialists to address such a clinically complex condition as IE.…”

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confidence: 99%