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Michelle M. Kim, MSc; Amber E. Barnato, MD, MPH; Derek C. Angus, MD, MPH; Lee F. Fleisher, MD; Jeremy M. Kahn, MD, MSc

Arch Intern Med. 2010;170(4):369-376.

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.

Author Affiliations: Department of Health Care Management and Economics, Wharton School of Business (Ms Kim), Leonard Davis Institute of Health Economics (Drs Fleisher and Kahn), Department of Anesthesia and Critical Care, School of Medicine (Dr Fleisher), Center for Clinical Epidemiology and Biostatistics, School of Medicine (Drs Fleisher and Kahn), and Division of Pulmonary, Allergy, and Critical Care, School of Medicine (Dr Kahn), University of Pennsylvania, Philadelphia; and Section of Decision Sciences and Clinical Systems Modeling, Division of General Internal Medicine, School of Medicine (Dr Barnato), CRISMA Laboratory, Department of Critical Care Medicine, School of Medicine (Drs Barnato and Angus), and Department of Health Policy and Management, Graduate School of Public Health (Drs Barnato and Angus), University of Pittsburgh, Pittsburgh, Pennsylvania.

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