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The impact of multidisciplinary team approach with critical care specialist and cardiologist co-management style on the clinical outcomes of cardiac intensive care unit patients.

Session Acute intensive cardiovascular care

Speaker William Weintraub

Event : ESC Congress 2015

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care
  • Session type : Rapid Fire Abstracts

Authors : Z Fanari (Newark,US), A Barekatain (Newark,US), R Kerzner (Newark,US), S Hammami (Newark,US), WS Weintraub (Newark,US), V Maheshwari (Newark,US)

Authors:
Z. Fanari1 , A. Barekatain1 , R. Kerzner1 , S. Hammami1 , W.S. Weintraub1 , V. Maheshwari2 , 1Christiana Hospital, Section of Cardiology - Newark - United States of America , 2Christiana Hospital, Section of Pulmonary & Critical Care Medicine. - Newark - United States of America ,

Citation:
European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 884

Background: There is increased complexity of patients' care in intensive care units that has motivated the involvement of critical care trained physicians as a part of multidisciplinary approach in medical, surgical and neurological ICUs. Multidisciplinary care has been less common in cardiac care units (CCUs).

Purpose: To determine whether a multidisciplinary team approach with a critical care specialists and cardiologist co-management style will impact the clinical outcomes of CCU patients.

Methods: A formal protocol was implemented starting July 2012 in a hospital whereby a medical intensivist integrated with the multidisciplinary team. This team included a cardiologist, a medical intensivist, a cardiology fellow, internal medicine residents and interns, ICU nurses, ICU pharmacist and respiratory therapists. Responsibilities were delineated in a fashion such that the intensivist primarily managed non-cardiac issues, deferring primary cardiologic issues to the cardiologist. Patients were divided to low, intermediate and high risk depending on their mortality risk based on APACHE III score.

Results: 2475 patients were included with 916 patients admitted in the 12 months before and 1516 admitted in the 12 months after intervention. Patients admitted after the intervention had a higher morbidity rate expressed by a higher mean APACHE III (56.26 vs. 53.87; P<0.001), SAPS II (44.49 vs. 41.49; P<0.001). Results showed that the implementation of the intensivist multidisciplinary team model was associated with a significant decrease in both CCU Mortality (3.52 vs. 5.85%; odds ratio OR=0.59; 95% CI (0.39–0.88); P=0.01) and in-hospital mortality (4.37 vs. 11.13%; OR=0.37; 95% CI (0.26–0.52); P<0.0001). Furthermore; there was also a significant reduction in both CICU length of stay (LOS) (2.46±3 vs. 2.84±3 days; P=0.006), hospital LOS (7.03±4.5 vs. 7.53±4.5 days; P=0.006) and days on ventilation for intubated patients (1.96±1 vs. 4.32±2.8; P=0.0001). The reduction in mortality and LOS was noticed mainly in intermediate and high risk patients, while the reduction in days on ventilation was seen in all subgroups.

Conclusion: The implementation of a multidisciplinary team approach where an intensivist and cardiologist co-manage the critical care of CCU patients is associated with reduced ICU and in-hospital mortality, ICU and in-hospital LOS and duration of mechanical ventilation

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