Erika J Yoo1, Jeffrey D Edwards2, Mitzi L Dean3, R Adams Dudley4. 1. Division of Pulmonary, Critical Care, and Sleep Medicine, Drexel University College of Medicine, Philadelphia, PA, USA erika.yoo@drexelmed.edu. 2. Division of Pediatric Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. 3. Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA. 4. 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.
Abstract
PURPOSE: 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. MATERIALS AND 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.
PURPOSE: 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. MATERIALS AND 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.
Authors: Rachel Kohn; Vanessa Madden; Jeremy M Kahn; David A Asch; Amber E Barnato; Scott D Halpern; Meeta Prasad Kerlin Journal: Ann Am Thorac Soc Date: 2017-02
Authors: Merrick Lopez; Yana Vaks; Michele Wilson; Kenneth Mitchell; Christina Lee; Janeth Ejike; Grace Oei; Danny Kaufman; Jamie Hambly; Cynthia Tinsley; Thomas Bahk; Carlos Samayoa; James Pappas; Shamel Abd-Allah Journal: Pediatr Qual Saf Date: 2019-05-16
Authors: David Hong; Ki Hong Choi; Yang Hyun Cho; Su Hyun Cho; So Jin Park; Darae Kim; Taek Kyu Park; Joo Myung Lee; Young Bin Song; Jin-Oh Choi; Joo-Yong Hahn; Seung-Hyuk Choi; Jin-Ho Choi; Kiick Sung; Hyeon-Cheol Gwon; Eun-Seok Jeon; Jeong Hoon Yang Journal: Ann Intensive Care Date: 2020-06-16 Impact factor: 6.925