The Effect of Multidisciplinary Care Teams on Intensive Care Unit Mortality

Abstract

Background Critically ill patients are medically complex and may benefit from a multidisciplinary approach to care. Methods We conducted a population-based retrospective cohort study of medical patients admitted to Pennsylvania acute hospitals (N=169) from July 1, 2004 to June 30, 2006, linking a statewide hospital organizational survey to hospital discharge data. Multivariate logistic regression was used to determine the independent relationship between daily multidisciplinary rounds and 30-day mortality. Results 112 hospitals and 107,324 patients were included in the final analysis. Overall 30-day mortality was 18.3%. After adjusting for patient and hospital characteristics, multidisciplinary care was associated with significant reductions in the odds of death (OR=0.84, 95% CI: 0.76–0.93, p=0.001). When stratifying by intensivist physician staffing, the lowest odds of death were in ICUs with high-intensity physician staffing and multidisciplinary care teams (OR=0.78, 95% CI: 0.68–0.89, p<0.0001), followed by ICUs with low intensity physician staffing and multidisciplinary care teams (OR=0.88, 95%CI: 0.79–0.97, p=0.014), compared to hospitals with low intensity physician staffing but without multidisciplinary care teams. The effects of multidisciplinary care were consistent across key subgroups including patients with sepsis, patients requiring invasive mechanical ventilation, and patients in the highest quartile of severity of illness Conclusions Daily rounds by a multidisciplinary team are associated with lower mortality among medical ICU patients. The survival benefit of intensivist physician staffing is in part explained by the presence of multidisciplinary teams in high-intensity staffed ICUs.

Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients

“…Examples include only 80% recognition of under dosing of vancomycin by pharmacists, less than 50% recognition of recurrent sepsis by physicians and less than 50% recognition of a D5 (5% dextrose) infusion in a patient with hyperglycaemia and hypervolemia by nurses. This variation of both intraand interprofessional recognition implies an average interprofessional team from our cohort could miss as much as 50% of safety issues supporting the persistence of patient safety issues during the theoretical safety net of interprofessional rounds (Arora, Patel, Engell, & LaRosa, 2013;Kim et al, 2010;Reason, 2000). Further, while it is likely that the worsening hemodynamics might have been caught by the average interprofessional rounding team, this study suggests that the imminent diagnosis of recurrent sepsis would be under-recognised, thus compromising the creation of an appropriate care plan for this patient.…”

“…In spite of different workflows in employing the EHR, data are shared from all team members during daily Interprofessional (interprofessional) rounds (Collins, Bakken, Vawdrey, Coiera, & Currie, 2011a). However, a safe and conscientious care plan can only be generated if the data presented by all members of the interprofessional rounding team are reliable and accurate (Kim, Barnato, Angus, Fleisher, & Kahn, 2010). Consequently, it is imperative that any interventions to improve or modify EHR function accounts for all representative professional groups.…”

Critical illness outcome study: an observational study of protocols and mortality in intensive care units

“…It is clear that multidisciplinary teams improve outcomes in ICU’s,[5,43] but the mechanism by which this occurs is not known. By studying protocol use in general, we are analyzing an approach to care standardization and not the practices themselves.…”

“…For example, variation has been documented in physician staffing, hours of staffing, the presence and role of medical directors and the presence of multidisciplinary rounding teams. [2-5] Heterogeneous care provided to ICU patients may be related in part to patient differences or a lack of medical consensus. However, some of this variation in care may be related to the general characteristics of the ICU itself and the practitioners who work there.…”

Training Internists to Meet Critical Care Needs in the United States

“…Most evidence supports involvement of trained intensivists in the care of the critically ill (5–9). Population demographics, particularly the aging U.S. population, the Leapfrog Group intensive care unit (ICU) staffing recommendations (10), and ACGME resident duty-hour limitations (11, 12) have increased the workload of intensivists and non-intensivist critical care providers (i.e., hospitalists, family practitioners, nurse practitioners, physician assistants) (13).…”