Expanded ICU teams reduce death rates, Pa. study found

Critically ill patients in intensive care units have lower death rates at hospitals that embrace a team approach to their care, according to a study in the Archives of Internal Medicine led by a University of Pennsylvania doctor.

The researchers, who also included doctors from Penn's Wharton School and the University of Pittsburgh, examined 107,324 patients in ICUs at 112 Pennsylvania hospitals from July 2004 through June 2006.

Over those two years, the overall 30-day mortality rate for ICU patients was 18.3 percent.

After the researchers adjusted for the type and severity of patients' illnesses, they found that "multidisciplinary teams were associated with a 16 percent reduction in the odds of death."

Such teams can include doctors, nurses, pharmacists, respiratory therapists, social workers and others.

While patients in ICUs are invariable treated by a large number of caregivers, the study looked for teams that visited the patients together every day.

Performing rounds together appears to improve communications and teamwork among the caregivers, said the study's senior author Jeremy M. Kahn.

"It's not just having all these people work on the patient," the Penn ICU doctor said. "Having them work on the patient together creates a whole that is better than the sum of its parts."

Each year more than 4 million patients are admitted to ICUs in the United States. And as the population ages that number is expected to rise, putting additional stress on hospitals, ICUs, and so-called intensivists, doctors who specialize in critical care. Kahn said that there is too many patients and ICUs for intensivists to cover.

"The percentage of hospital patients who are in ICUs is rising," Kahn said. "We need to find innovative ways to provide high quality care for these people, but we can't put an intensivist in ever ICU.

The study suggests that even with intensivists in short supply, lower death rates can be achieved by expanding participation in ICUs to a broader range of health-care providers.

"We demonstrated that daily rounds by a multidisciplinary care team are associated with lower mortality in the ICU," the study's authors concluded. "Clinicians, hospital administrators, and policy makers can use these results to help optimally organize critical care services and potentially improve outcomes for critically ill patients."