To determine the impact on clinical outcomes of a team approach to the care of patients admitted to an adult intensive care unit (ICU).
We designed and implemented a multidisciplinary team approach to provide recommendations and assistance in the care of patients admitted to a 16-bed medical/surgical ICU at Cookeville Regional Medical Center, a 176-bed community hospital. The team consisted of a critical care physician, a nurse supervisor, a clinical pharmacist, a respiratory therapist and other allied health personnel. We compared all patients admitted after implementation (1/1/2004 to 9/30/04) with historical controls (patients admitted between 1/1/2003 and 9/30/2003). Values are expressed as mean ± SD (median).
Before implementation, 1102 patients were admitted to the ICU, 278 of them requiring mechanical ventilation. After implementation, 1145 were admitted, 282 requiring MV (NS). Mechanical ventilation length was shorter after implementation of the team, 3.4 ± 3.8 (median 2.0) days compared with 5.2 ± 4.6 (median 4.0) days in the control group, p=0.0438. Mortality and ICU length of stay (LOS) outcomes for patients requiring and not requiring MV can be seen in tables 1 and 2.
In patients not requiring MV, ICU LOS was shorter for patients admitted after implementation of the team compared with controls. For patients requiring MV, ICU LOS was the same but length of MV was shorter in patients admitted after implementation. Mortality was unchanged by our intervention.
A multidisciplinary ICU team approach appears to improve some patient outcome measures in a community hospital ICU setting. Similar findings had been previously reported only in large centers.Table1—
Clinical Outcomes of Patients Requiring Mechanical VentilationBefore Implementation N=278After Implementation N=284p ValueMortality71 (25.5%)72 (25.4%)p>0.9999ICU LOS (days)5.4 ± 7.0 (median 2.75)4.9 ± 4.7 (median 3.25)p=0.3066
Ian Morales, None.