Controlled trial of multidisciplinary care teams for acutely ill medical inpatients: enhanced multidisciplinary care.
BACKGROUND
Acute hospital general medicine services care for ageing complex patients, using the skills of a range of health-care providers. Evidence suggests that comprehensive early assessment and discharge planning may improve efficiency and outcomes of care in older medical patients.


OBJECTIVE
To enhance assessment, communication, care and discharge planning by restructuring consistent, patient-centred multidisciplinary teams in a general medicine service.


METHODS
Prospective controlled trial enrolling 1538 consecutive medical inpatients. Intervention units with additional allied health staff formed consistent multidisciplinary teams aligned with inpatient admitting units rather than wards; implemented improved communication processes for early information collection and sharing between disciplines; and specified shared explicit discharge goals. Control units continued traditional, referral-based multidisciplinary models with existing staffing levels.


RESULTS
Access to allied health services was significantly enhanced. There was a trend to reduced index length of stay in the intervention units (7.3 days vs 7.8 days in control units, P = 0.18), with no change in 6-month readmissions. In-hospital mortality was reduced from 6.4 to 3.9% (P = 0.03); less patients experienced functional decline in hospital (P = 0.04) and patients' ratings of health status improved (P = 0.02). Additional staffing costs were balanced by potential bed-day savings.


CONCLUSIONS
This model of enhanced multidisciplinary inpatient care has provided sustainable efficiency gains for the hospital and improved patient outcomes.
Mudge
A
A
Department of Internal Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. alison_mudge@health.qld.gov.au
Laracy
S
S
Richter
K
K
Denaro
C
C
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D007388:Internal Medicine / Q000379:methods*; D007400:Interprofessional Relations; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies