O impacto do cuidado multidisciplinar no paciente crítico

INTRODUCTION

Over four million intensive care unit (ICU) admissions occur annually in the United States each year.1 These patients are often at high risk of death—mortality for critical illness syndromes such as acute lung injury and sepsis ranges from 25 to 50% and 20% of Americans die with intensive care services.2–5 One approach to lowering ICU mortality is to optimize the organization of ICU services.6 For example, a large body of literature indicates that the presence of trained intensivist physicians is associated with improved survival,7 leading many policy makers to call for expansion of the intensivist-led model of critical care.8 Unfortunately there are not enough trained intensivists to meet either current or future demand, and only a minority of ICUs are currently staffed in this manner.9, 10

A potential complement to intensivist staffing is a multidisciplinary care model in which physicians, nurses, respiratory therapists, clinical pharmacists, and other staff members provide critical care as a team. A multidisciplinary approach acknowledges the complexitiesof modern critical care and the important role of communication between providers in delivering comprehensive care. Such a model is endorsed by the Society of Critical Care Medicine and the American Association of Critical Care Nurses11, 12. Yet, unlike intensivist physician staffing, little research has systematically evaluated the relationship between multidisciplinary care and outcomes, and there are few data to justify widespread adoption of this approach. Existing studies are generally single center in nature with limited ability to adjust for variations in case-mix or temporal trends between time periods.13–15

The objective of our study was to determine the independent effect of multidisciplinary care teams on the mortality of critically ill patients, using a multi-center hospital-level organizational survey and patient-level outcomes data. We also sought to determine the interaction between multidisciplinary care teams and intensivist physician staffing to see if part of the benefit of intensivist staffing could be explained by multidisciplinary care. We hypothesized that multidisciplinary care teams would be associated with improved critical care survival, particularly in settings without high-intensity physician staffing.

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