Impact of a Multidisciplinary Team Approach Including an Intensivist on the Outcomes of Critically Ill Patients in the Cardiac Care Unit

Objective: To investigate the impact of integrating a medical intensivist into a cardiac care unit (CCU) multidisciplinary team on the outcomes of CCU patients. Patients and Methods: 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, a medical intensivist, medical house staff, nurses, a pharmacist, a dietitian, and physical 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. Results: 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 ventilation duration (2.0 +/- 1.0 vs 4.3 +/- 2.5 days; P <. 01). Conclusion: 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. (C) 2016 Mayo Foundation for Medical Education and Research