Multidisciplinary Critical Care and Intensivist Staffing: Results of a Statewide Survey and Association With Mortality.
OBJECTIVE
The role of multidisciplinary teams in improving the care of intensive care unit (ICU) patients is not well defined, and it is unknown whether the use of such teams helps to explain prior research suggesting improved mortality with intensivist staffing. We sought to investigate the association between multidisciplinary team care and survival of medical and surgical patients in nonspecialty ICUs.


METHODS
We conducted a community-based, retrospective cohort study of data from 60 330 patients in 181 hospitals participating in a statewide public reporting initiative, the California Hospital Assessment and Reporting Taskforce (CHART). Patient-level data were linked with ICU organizational data collected from a survey of CHART hospital ICUs between December 2010 and June 2011. Clustered logistic regression was used to evaluate the independent effect of multidisciplinary care on the in-hospital mortality of medical and surgical ICU patients. Interactions between multidisciplinary care and intensity of physician staffing were examined to explore whether team care accounted for differences in patient outcomes.


RESULTS
After adjustment for patient characteristics and interactions, there was no association between team care and mortality for medical patients. Among surgical patients, multidisciplinary care was associated with a survival benefit (odds ratio 0.79; 95% confidence interval (CI), 0.62-1.00; P = .05). When stratifying by intensity of physician staffing, although the lowest odds of death were observed for surgical patients cared for in ICUs with multidisciplinary teams and high-intensity staffing (odds ratio, 0.77; 95% CI, 0.55-1.09; P = .15), followed by ICUs with multidisciplinary teams and low-intensity staffing (odds ratio 0.84, 95% CI 0.65-1.09, p = 0.19), these differences were not statistically significant.


CONCLUSIONS
Our results suggest that multidisciplinary team care may improve outcomes for critically ill surgical patients. However, no relationship was observed between intensity of physician staffing and mortality.
Division of Pulmonary, Critical Care, and Sleep Medicine, Drexel University College of Medicine, Philadelphia, PA, USA erika.yoo@drexelmed.edu.
Erika J
EJ
Yoo
Division of Pediatric Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Jeffrey D
JD
Edwards
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
Mitzi L
ML
Dean
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA.
R Adams
RA
Dudley
D002140:California / Q000453:epidemiology; D003131:Combined Modality Therapy; D003422:Critical Care / Q000458:organization & administration*; D016638:Critical Illness / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008875:Middle Aged; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D000078329:Workforce
ICU organization; ICU outcomes; ICU staffing; multidisciplinary critical care