Studies Examine Team Approaches to Hospital Care

Multidisciplinary care teams consisting of clinicians, nurses, and other healthcare professionals appear to be associated with a lower risk of death among patients in the intensive care unit, according to a report in the Archives of Internal Medicine. A second report finds that an increasing number of surgical patients are being managed jointly by a surgeon and another clinician, such as a hospitalist or internal medicine subspecialist.

More than 4 million patients are admitted to the ICU each year, according to background information in the first article. These patients are often at a high risk of death from conditions such as sepsis and acute lung injury. Studies have shown that the presence of trained intensivist physicians is associated with improved survival, but there are not enough of these clinicians to meet demand.

“A potential complement to intensivist staffing is a multidisciplinary care model in which physicians, nurses, respiratory therapists, clinical pharmacists and other staff members provide critical care as a team,” wrote Michelle M. Kim, MSc, of the University of Pennsylvania, and colleagues.

The researchers analyzed data from 107,324 patients admitted to 112 acute care hospitals between 2004 and 2006. Daily rounds conducted by a multidisciplinary care team were independently associated with a lower risk of death among ICU patients. Of the hospitals, 22 (19.6%) had an intensivist either consulting on or managing all cases and also had daily rounds conducted by a multidisciplinary care team. Patients at these hospitals were least likely to die, followed by patients at facilities without intensivist care but with multidisciplinary care teams.

Several mechanisms could explain the association, they noted. “Multidisciplinary rounds may facilitate implementation of best clinical practices such as evidence-based treatments for acute lung injury, sepsis and prevention of ICU complications. Pharmacist participation on rounds is associated with fewer adverse drug events and alone may be associated with lower mortality among ICU patients. Multidisciplinary rounds may also improve communication between healthcare providers.”

The findings have implications for organizing critical care services, the authors conclude. “Based on these results and expert opinion voiced in consensus guidelines, it is reasonable for hospitals to implement routine multidisciplinary rounds when staffing capabilities allow,” they wrote. “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.”

Source: American Medical Association