Team-Based Approach Improves Intensive Care Outcomes

Replacing intensivist-led teams with multidisciplinary care teams can reduce the risk of dying in intensive care units (ICUs), according to a new study.

Researchers at the University of Pennsylvania (Penn, Philadelphia, USA) conducted a population-based retrospective cohort study of 107,324 patients admitted to 112 acute care hospitals in the state of Pennsylvania (USA) between July 1, 2004, and June 30, 2006, linking the data to the respective hospital discharge data. Multivariate logistic regression was used to determine the independent relationship between daily multidisciplinary rounds and 30-day mortality, comparing the outcomes from ICUs that were and those that were not staffed by intensivists. The researchers found that a multidisciplinary approach to care teams, with or without an intensivist, was associated with a 16% reduction in the odds of death, comparable to the results of an intensivist alone. When hospitals employed both a multidisciplinary care team and an intensivist physician, there was a 22% reduction in the risk of death during an ICU stay. Importantly, a multidisciplinary approach in the absence of trained intensivist was associated with a significant 12% reduction in mortality.

The researchers offered several explanations for the impact of the multidisciplinary care team model, including the implementation of best practices, the application of evidence-based treatments, pharmacists identifying potential adverse drug indications, and implementation of respiratory therapy, and nurse-driven protocols to reduce ventilation time and shorten ICU length of stay. The study was published in the February 22, 2010, issue of the Archives of Internal Medicine.

"Hospitals without intensivists can still achieve significant reductions in mortality in their ICUs by implementing a multidisciplinary, team-based approach,” said lead author Jeremy Kahn, M.D., M.S., an assistant professor of medicine at the Penn School of Medicine. "Patient outcomes are improved when physicians, nurses, respiratory therapists, clinical pharmacists, and other staff members work together to provide critical care as a team.”

The severe shortage of specially trained intensive care physicians has hospital ICUs across the United States struggling to staff units with critical care teams led by intensivists. Even though the presence of these specially trained physicians reduces the risk of death for patients in the ICU, there are not enough trained intensivists to meet either current or future demand, and only a minority of ICUs is staffed with intensivists.

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