Impact of multidisciplinary healthcare team in mortality and readmission rate in a brazilian cardiac intensive care unit
Introduction:
The growth in the complexity of health care has been accompanied by the need for greater collaborative actions
and sharing of information in intensive care units (ICU). The incorporation of daily rounds by a multidisciplinary
care team allows better decision making, which results in the improvement of quality of care. The objective of
this study was to determine the impact of a multidisciplinary healthcare team on mortality and readmissions of
CICU patients.
Methods:
The database from a cardiac ICU of a medium-sized hospital in Brazil was analyzed to conduct this study.
Admissions during the years of 2013 and 2015 were compared, using variables of equity and performance. In
2013, daily rounds were conducted by physicians, nurses and a physiotherapist; whereas, in 2015 the
multidisciplinary round was fully equipped with the additional presence of phonoaudiologists, pharmacists,
dentists and nutritional professionals. Data were collected from EPIMED MONITOR system and statistically
analyzed using EPI INFO, version 3.5.2 software. We considered two tailed test with p<0.05 significant, and confidence intervals of 95% (95% CI) were used for multivariate logistic regressions.
Results:
The populations analyzed during 2013 and 2015, respectively, were characteristically similar: number of
admissions (715 and 758), mean age (67.9±13.8 and 67.8±13.4), higher proportion of male patients (54.71% and
59.07%), three main diagnoses (coronary angiography with stent, unstable angina, acute ST elevation myocardial
infarction). However, during admission the 2015 group averaged a higher SAPS3 score (42.6±11.6 against
40±13.3), indicating these patients were significantly more severe (T statistic=4.0530; p=0.0001). The rate of
readmissions was 22.08% without the multidisciplinary team and 11.20% when this assistance was implemented,
a significant decrease (OR=0.4452 95%CI=0.3343 – 0.5930 p<0.001). Readmissions within 24 hours decreased from a total of 5 to none between 2013 and 2015 (p=0.021). The mortality rate (13.3% and 9.5%) was also significantly lower in the group exposed to the multidisciplinary healthcare team (OR=0,6850 IC95%=0,4949-0,9480 p=0,0219).
Conclusions:
Despite the greater severity of patients in the 2015 group, we observed lower mortality and readmission rates in
the group of patients attended by a multidisciplinary healthcare team.
References:
Kim M, 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.