Kim MM, Barnato AE, Angus DC, Fleisher LF, Kahn JM. The Effect of Multidisciplinary Care Teams on Intensive Care Unit Mortality. Arch Intern Med. 2010;170(4):369-376 [PubMed | Link to full text from IHI]

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

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Comment: This study provides evidence to support multidisciplinary teams as an organizational strategy in adult ICUs. Unfortunately there is little in these findings to illuminate what specifically about such teams creates a better result - measured in this study as lower mortality. While the authors speculate on the effect of daily rounds, communication and the ability of teams to influence the following of evidence-based practice, there was no analysis and investigation offered in support. This empirical study will serve to reinforce the face value of multidisciplinary teams and clinical work. More detailed investigation of the specific reasons for positive effects multidisciplinary teams have on care outcomes is needed to guide change. In your experience what makes a multidisciplinary team effective? How are you including parents as one of the 'disciplines'?

Jim Handyside