Impact of a Multidisciplinary Team Approach Including an Intensivist on the Outcomes of Critically Ill Patients in the Cardiac Care Unit.
Impact of a Multidisciplinary Team Approach Including an Intensivist on the Outcomes of Critically Ill Patients in the Cardiac Care Unit.
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DOI：
10.1016/j.mayocp.2016.08.004
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发表时间：
2016-12
影响因子：
8.9
通讯作者：
Maheshwari V
中科院分区：
文献类型：
--
作者：
Fanari Z;Barekatain A;Kerzner R;Hammami S;Weintraub WS;Maheshwari V
研究将医学重症监护医师整合到心脏监护病房（CCU）多学科团队对CCU患者结局的影响。我们对2011年7月1日至2013年7月1日期间的2239例CCU入院患者进行了回顾性队列研究，这些患者包括在CCU多学科团队引入重症监护医师之前12个月和之后12个月入院的患者。该团队包括一名心脏病专家、一名重症监护医生、研究员和住院医生、CCU护士、一名药剂师和呼吸治疗师。主要结局为CCU死亡率。次要结局包括住院死亡率、CCU住院时间、住院时间和机械通气持续时间。在实施多学科团队方法后，校正的CCU死亡率（3.5% vs 5.9%; P= 0.01）和住院死亡率（4.4% vs 11.1%; P<0.01）均显著降低。对校正后的CCU平均住院时间（2.5±2.0 vs 2.9±2.0天; P<0.01）、校正后的平均住院时间（7.0±4.5 vs 7.5±4.5天; P<0.01）和校正后的平均持续时间（2.0±1.0 vs 4.3±2.5天; P<0.01）观察到类似的影响。实施多学科团队方法，其中重症监护医师和心脏病专家共同管理CCU患者的重症监护是可行的，并可能导致更好的患者结局。
To investigate the impact of integrating a medical intensivist into a cardiac care unit (CCU) multidisciplinary team on the outcomes of CCU patients. We conducted a retrospective cohort study of 2239 CCU admissions between July 1, 2011, and July 1, 2013, which constituted patients admitted in the 12 months before and 12 months after the introduction of intensivists into the CCU multidisciplinary team. This team included a cardiologist, an intensivist, fellows and residents, CCU nurses, a pharmacist, and respiratory therapists. The primary outcome was CCU mortality. Secondary outcomes included hospital mortality, CCU length of stay, hospital length of stay, and duration of mechanical ventilation. After the implementation of a multidisciplinary team approach, there was a significant decrease in both adjusted CCU mortality (3.5% vs 5.9%; P=.01) and hospital mortality (4.4% vs 11.1%; P<.01). A similar impact was observed on adjusted mean CCU length of stay (2.5±2.0 vs 2.9±2.0 days; P<.01), adjusted mean hospital length of stay (7.0±4.5 vs 7.5±4.5 days; P<.01), and adjusted mean duration (2.0±1.0 vs 4.3±2.5 days; P<.01). The implementation of a multidisciplinary team approach in which an intensivist and a cardiologist comanage the critical care of CCU patients is feasible and may result in better patient outcomes.