Multidisciplinary teams cut ICU mortality
MedWire News: Critically ill patients are less likely to die if they are treated in an intensive care unit (ICU) that benefits from daily rounds by a multidisciplinary team, say US researchers.
In units with low-intensity staffing, the presence of a multidisciplinary team improved patient outcomes nearly to those achieved in ICUs with high-intensity physician staffing, they report in the Archives of Internal Medicine.
“These results suggest that in hospitals without high-intensity physician staffing, multidisciplinary rounds are likely to improve patient outcomes,” say Jeremy Kahn (University of Pennsylvania School of Medicine, Philadelphia) and colleagues.
The team studied outcomes of 107,324 patients admitted to 112 ICUs in Pennsylvania. The overall mortality rate was 18.3%.
Multidisciplinary care, where patients were assessed by a physician, nurse, and other healthcare professionals, such as a clinical pharmacist or respiratory therapist, was associated with an overall 16% reduction in patient mortality, after accounting for patient and hospital variables.
The highest risk for death, after accounting for confounders, occurred in ICUs with low-intensity physician staffing and no multidisciplinary rounds. The presence of a multidisciplinary team decreased mortality risk by 12%, which was almost in line with the 16% reduction achieved by high-intensity staffing.
The combination of high-intensity staffing and a multidisciplinary team was associated with the largest reduction in mortality risk, of 22%.
In subanalyses, the benefits of multidisciplinary care and high-intensity staffing were consistent for patients with sepsis, those requiring mechanical ventilation, and those in the highest quartile of severity of illness.
“Workforce analyses suggest that these are not enough intensivists to meet demand, and as a consequence only a minority of ICUs in the USA are staffed by trained intensivists,” say Kahn and colleagues.
“Directors of ICUs report that lack of enough trained intensivists is a key barrier to implementing an intensivist model of care.”
They conclude: “Our study shows that hospitals without the ability to implement high-intensity physician staffing can still achieve significant mortality reductions by implementing a multidisciplinary, team-based approach.”
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By Eleanor McDermid