The effect of multidisciplinary care teams on intensive care unit mortality.
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 care 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
A total of 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 (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.76-0.93 [P = .001]). When stratifying by intensivist physician staffing, the lowest odds of death were in intensive care units (ICUs) with high-intensity physician staffing and multidisciplinary care teams (OR, 0.78; 95% CI, 0.68-0.89 [P < .001]), followed by ICUs with low-intensity physician staffing and multidisciplinary care teams (OR, 0.88; 95% CI, 0.79-0.97 [P = .01]), compared with 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 physician-staffed ICUs.
Kim
Michelle M
MM
Department of Health Care Management and Economics, Wharton School of Business, University of Pennsylvania, Philadelphia, PA 19104, USA.
Barnato
Amber E
AE
Angus
Derek C
DC
Fleisher
Lee A
LA
Fleisher
Lee F
LF
Kahn
Jeremy M
JM
D015331:Cohort Studies; D003422:Critical Care / Q000458:organization & administration*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010414:Pennsylvania; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D012189:Retrospective Studies; D012307:Risk Factors