The Effect of Multidisciplinary Rounds on Intensive Care Unit Mortality 6.3.09
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This study examined the effect of multidisciplinary rounds on mortality in intensive care units (ICUs). The study analyzed data from 107,324 patients admitted to 112 hospitals. Hospitals were grouped based on physician staffing patterns and presence of multidisciplinary care teams. The results showed that multidisciplinary care was associated with lower 30-day mortality, and this benefit was greater in hospitals with high intensity physician staffing and multidisciplinary teams. Daily multidisciplinary rounds can help reduce mortality among ICU patients.
![The effect of multidisciplinary rounds on intensive care unit mortality Michelle M. Kim MSc, Amber E. Barnato MD MPH, Derek C. Angus MD MPH, Lee F. Fleisher MD and Jeremy M. Kahn MD MS Department of Health Care Management and Economics, Wharton School of Business; Departments of Medicine and Anesthesia and Critical Care, University of Pennsylvania School of Medicine; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, Departments of Medicine, Health Policy and Management, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Results ,[object Object],[object Object],Background ,[object Object],Objectives ,[object Object],[object Object],Conclusions ,[object Object],[object Object],[object Object],Limitations Policy Implications ,[object Object],[object Object],[object Object],Table 2. Association between organizational model and mortality Variable Odds Ratio (95% CI) Model 1: Multidisciplinary care staffing alone No multidisciplinary care 1.00 Multidisciplinary care 0.84 (0.76-0.93) Model 2: Intensivist physician staffing alone Low intensity 1.00 High intensity 0.84 (0.75-0.94) Model 3: Interaction between intensivist physician staffing and multidisciplinary care Low intensity/ no multidisciplinary care 1.00 Low intensity/ multidisciplinary care 0.88 (0.79-0.97) High intensity/ multidisciplinary care 0.78 (0.68-0.89) Models were adjusted for age, gender, admission source, Elixhauser comorbidities, mechanical ventilation status, MediQual severity score, primary diagnosis, teaching status, ICU type, region, and annual volume. Total n = 107,324. Table 1. Hospital and Patient Characteristics Low intensity no MDC Low intensity MDC High intensity MDC Hospital characteristics N=54 N=36 N=22 Teaching 12 (22) 14 (39) 15(68) Number of beds 128 [77-208] 198 [83.5-311] 286 [144-645] Annual med ICU admissions 272 [147-402] 380 [196-705] 58 [304-1103] Medical ICU 2 (4) 4 (11) 9 (41) Combined ICU 52 (96) 32 (89) 13 (59) ICU beds 11 [6-16] 15 [9-29] 21 [16-48] Patient Characteristics N=39,549 N=34,348 N=33,427 Age (mean) 65.4 64.3 62.0 Female (%) 50.7 50.7 48.9 Black (%) 5.8 12.8 18.2 Mechanical Ventilation (%) 17.0 26.2 31.3 ICU length of stay, median [IQR] 2 [1-4] 2 [1-5] 2 [1-5] ICU = intensive care unit ; MDC= multidisciplinary care ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Methods](https://image.slidesharecdn.com/kahnjeremy-theeffectofmultidisciplinaryroundsonintensivecareunitmortality-6-3-09-100819090817-phpapp02/85/The-Effect-of-Multidisciplinary-Rounds-on-Intensive-Care-Unit-Mortality-6-3-09-1-320.jpg)
![Table 1. Hospital,Intensive Care Unit, Patient Characteristics Low intensity/no multidisciplinary care Low intensity/ multidisciplinary care High intensity/ multidisciplinary care (n=54) (n=36) (n=22) Hospital characterisitcs Teaching 12(22) 14 (39) 15(68) Number of beds 128 [77- 208] 198 [83.5-311] 286 [144-645] Annual med ICU admissions 272 [147- 402] 380 [196-705] 588 [304-1103] ICU characterisitcs ICU: Medical 2 (4) 4 (11) 9 (41) Combined 52(96) 32 (89) 13 (59) Number of beds 11 [6-16] 15 [9-29] 21 [16-48] Patient characteristics Age 65.4 ± 17.9 64.3 ± 18.6 62.0 ± 17.8 Female (%) 50.7 50.7 48.9 Black (%) 5.8 12.8 18.2 ICU = intensive care unit Values are expressed as a frequency (percent), median [interquartile range], or {range}.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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The Effect of Multidisciplinary Rounds on Intensive Care Unit Mortality 6.3.09
- 2. Table 1. Hospital,Intensive Care Unit, Patient Characteristics Low intensity/no multidisciplinary care Low intensity/ multidisciplinary care High intensity/ multidisciplinary care (n=54) (n=36) (n=22) Hospital characterisitcs Teaching 12(22) 14 (39) 15(68) Number of beds 128 [77- 208] 198 [83.5-311] 286 [144-645] Annual med ICU admissions 272 [147- 402] 380 [196-705] 588 [304-1103] ICU characterisitcs ICU: Medical 2 (4) 4 (11) 9 (41) Combined 52(96) 32 (89) 13 (59) Number of beds 11 [6-16] 15 [9-29] 21 [16-48] Patient characteristics Age 65.4 ± 17.9 64.3 ± 18.6 62.0 ± 17.8 Female (%) 50.7 50.7 48.9 Black (%) 5.8 12.8 18.2 ICU = intensive care unit Values are expressed as a frequency (percent), median [interquartile range], or {range}.
- 3. Table 1. Hospital,Intensive Care Unit, Patient Characteristics Low intensity/no multidisciplinary care Low intensity/ multidisciplinary care High intensity/ multidisciplinary care (n=54) (n=36) (n=22) Hospital characterisitcs Teaching 12 (22) 14 (39) 15(68) Number of beds 128 [77-208] 198 [83.5-311] 286 [144-645] Annual med ICU admissions 272 [147-402] 380 [196-705] 588 [304-1103] ICU characterisitcs Medical ICU 2 (4) 4 (11) 9 (41) Combined Icu 52 (96) 32 (89) 13 (59) Number of beds 11 [6-16] 15 [9-29] 21 [16-48] Patient characteristics Age 65.4 ± 17.9 64.3 ± 18.6 62.0 ± 17.8 Female (%) 50.7 50.7 48.9 Black (%) 5.8 12.8 18.2 ICU = intensive care unit Values are expressed as a frequency (percent), median [interquartile range], or {range}.
- 4. Table 1. Hospital,Intensive Care Unit, Patient Characteristics Low intensity/no multidisciplinary Low intensity/ multidisciplinary High intensity/ multidisciplinary (n=54) (n=36) (n=22) Hospital characterisitcs Teaching 12 (22) 14 (39) 15(68) Number of beds 128 [77-208] 198 [83.5-311] 286 [144-645] Annual med ICU admissions 272 [147-402] 380 [196-705] 588 [304-1103] ICU characterisitcs Medical ICU 2 (4) 4 (11) 9 (41) Combined Icu 52 (96) 32 (89) 13 (59) Number of beds 11 [6-16] 15 [9-29] 21 [16-48] Patient characteristics Age 65.4 ± 17.9 64.3 ± 18.6 62.0 ± 17.8 Female (%) 50.7 50.7 48.9 Black (%) 5.8 12.8 18.2 ICU = intensive care unit Values are expressed as a frequency (percent), median [interquartile range], or {range}
- 5. Table 2. Association between organizational models and 30-day mortality a Variable Odds Ratio (95% CI) Model 1: Multidisciplinary care staffing alone No multidisciplinary care 1.00 Multidisciplinary care 0.84 (0.76-0.93) Model 2: Intensivist physician staffing alone Low intensity 1.00 High intensity 0.84 (0.75-0.94) Model 3: Interaction between intensivist physician staffing and multidisciplinary care teams Low intensity/ no Multidisciplinary care 1.00 Low intensity/ multidisciplinary care 0.88 (0.79-0.97) High intensity/ multidisciplinary care 0.78 (0.68-0.89) a Models were adjusted for age, gender, admission source, Elixhauser comorbidities, mechanical ventilation status, MediQual severity score, primary diagnosis, teaching status, ICU type, region, and annual volume. Total n = 107,324. Table 1. Association between intensivist physician staffing and 30-day mortality for all patients a Model 1: Multidisciplinary care staffing alone Model 2: Intensivist physician staffing alone Model 3: Interaction between intensivist physician staffing and multidisciplinary care teams Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) No multidisciplinary care 1.00 Low intensity 1.00 Low intensity/no multidisciplinary care 1.00 Multidisciplinary care 0.84 High intensity 0.84 Low intensity/ multidisciplinary care 0.88 (0.76-0.93) (0.75-0.94) (0.79-0.97) High intensity/ multidisciplinary care 0.78 (0.68-0.89) a Models were adjusted for age, gender, admission source, Elixhauser comorbidities, mechanical ventilation status, MediQual severity score, primary diagnosis, teaching status, ICU type, region, and annual volume. Total n = 107,324.
- 6. Table 1. Association between intensivist physician staffing and 30-day mortality for all patients a Model 1: Multidisciplinary care staffing alone Model 2: Intensivist physician staffing alone Model 3: Interaction between intensivist physician staffing and multidisciplinary care teams Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) No multidisciplinary care 1.00 Low intensity/no multidisciplinary care 1.00 Multidisciplinary care 0.84 Low intensity/ multidisciplinary care 0.88 (0.76-0.93) 1.00 Low intensity (0.79-0.97) 0.84 High intensity High intensity/ multidisciplinary care 0.78 (0.68-0.89) a Models were adjusted for age, gender, admission source, Elixhauser comorbidities, mechanical ventilation status, MediQual severity score, primary diagnosis, teaching status, ICU type, region, and annual volume. Total n = 107,324.
- 7. Table 1. Association between intensivist physician staffing and 30-day mortality for all patients a Model 1: Multidisciplinary care staffing alone Model 2: Intensivist physician staffing alone Model 3: Interaction between intensivist physician staffing and multidisciplinary care teams Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) No multidisciplinary care 1.00 Low intensity 1.00 Low intensity/no multidisciplinary care 1.00 Multidisciplinary care 0.84 High intensity 0.84 Low intensity/ multidisciplinary care 0.88 (0.76-0.93) (0.75-0.94) (0.79-0.97) High intensity/ multidisciplinary care 0.78 (0.68-0.89) a Models were adjusted for age, gender, admission source, Elixhauser comorbidities, mechanical ventilation status, MediQual severity score, primary diagnosis, teaching status, ICU type, region, and annual volume. Total n = 107,324.
- 8. Table 1. Association between intensivist physician staffing and 30-day mortality for all patients a Model 1: Multidisciplinary care staffing alone Model 2: Intensivist physician staffing alone Model 3: Interaction between intensivist physician staffing and multidisciplinary care teams Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) No multidisciplinary care 1.00 Low intensity 1.00 Low intensity/no multidisciplinary care 1.00 Multidisciplinary care 0.84 High intensity 0.84 Low intensity/ multidisciplinary care 0.88 (0.76-0.93) (0.75-0.94) (0.79-0.97) High intensity/ multidisciplinary care 0.78 (0.68-0.89) a Models were adjusted for age, gender, admission source, Elixhauser comorbidities, mechanical ventilation status, MediQual severity score, primary diagnosis, teaching status, ICU type, region, and annual volume. Total n = 107,324.
- 9. Table 1. Association between intensivist physician staffing and 30-day mortality for all patients a Model 1: Multidisciplinary care staffing alone Model 2: Intensivist physician staffing alone Model 3: Interaction between intensivist physician staffing and multidisciplinary care teams Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) No multidisciplinary care 1.00 Low intensity 1.00 Low intensity/no multidisciplinary care 1.00 Multidisciplinary care 0.84 High intensity 0.84 Low intensity/ multidisciplinary care 0.88 (0.76-0.93) (0.75-0.94) (0.79-0.97) High intensity/ Multidisciplinary care 0.78 (0.68-0.89) a Models were adjusted for age, gender, admission source, Elixhauser comorbidities, mechanical ventilation status, MediQual severity score, primary diagnosis, teaching status, ICU type, region, and annual volume. Total n = 107,324.
- 10. Table 1. Association between intensivist physician staffing and 30-day mortality for all patients a Model 1: Multidisciplinary care staffing alone Model 2: Intensivist physician staffing alone Model 3: Interaction between intensivist physician staffing and multidisciplinary care teams Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) No multidisciplinary care 1.00 Low intensity 1.00 Low intensity/no multidisciplinary care 1.00 Multidisciplinary care 0.84 High intensity 0.84 Low intensity/ multidisciplinary care 0.88 (0.76-0.93) (0.75-0.94) (0.79-0.97) High intensity/ multidisciplinary care 0.78 (0.68-0.89) a Models were adjusted for age, gender, admission source, Elixhauser comorbidities, mechanical ventilation status, MediQual severity score, primary diagnosis, teaching status, ICU type, region, and annual volume. Total n = 107,324.
- 11. Table 3. Association between intensivist physician staffing and 30-day mortality for all patients* Model 1: Multidisciplinary care staffing alone Model 2: Intensivist physician staffing alone Model 3: Interaction between intensivist physician staffing and multidisciplinary care teams Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) No multidisciplinary care 1.00 Low intensity 1.00 Low intensity/no multidisciplinary care 1.00 Multidisciplinary care 0.84 High intensity 0.83 Low intensity/ multidisciplinary care 0.88 (0.76-0.93) (0.74-0.93) (0.80-0.97) High intensity/ multidisciplinary care 0.77 (0.68-0.88) *Models were adjusted for age, gender, admission source, Elixhauser comorbidities, mechanical ventilation status, MediQual severity score, primary diagnosis, teaching status, ICU type, region, and annual volume. Total n = 86,286.
- 12. Table 3. Association between intensivist physician staffing and 30-day mortality for all patients* Model 1: Multidisciplinary care staffing alone Model 2: Intensivist physician staffing alone Model 3: Interaction between intensivist physician staffing and multidisciplinary care teams Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) No multidisciplinary care 1.00 Low intensity 1.00 Low intensity/no multidisciplinary care 1.00 Multidisciplinary care 0.84 High intensity 0.83 Low intensity/ multidisciplinary care 0.88 (0.76-0.93) (0.74-0.93) (0.80-0.97) High intensity/ multidisciplinary care 0.77 (0.68-0.88) *Models were adjusted for age, gender, admission source, Elixhauser comorbidities, mechanical ventilation status, MediQual severity score, primary diagnosis, teaching status, ICU type, region, and annual volume. Total n = 86,286.
- 13. Table 3. Association between intensivist physician staffing and 30-day mortality for all patients* Model 1: Multidisciplinary care staffing alone Model 2: Intensivist physician staffing alone Model 3: Interaction between intensivist physician staffing and multidisciplinary care teams Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) Variable Odds Ratio (95% CI) No multidisciplinary care 1.00 Low intensity 1.00 Low intensity/no multidisciplinary care 1.00 Multidisciplinary care 0.84 High intensity 0.83 Low intensity/ multidisciplinary care 0.88 (0.76-0.93) (0.74-0.93) (0.80-0.97) High intensity/ multidisciplinary care 0.77 (0.68-0.88) *Models were adjusted for age, gender, admission source, Elixhauser comorbidities, mechanical ventilation status, MediQual severity score, primary diagnosis, teaching status, ICU type, region, and annual volume. Total n = 86,286.