Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2018 Oct 11;13(10):e0205528. doi: 10.1371/journal.pone.0205528. eCollection 2018.
A multidisciplinary approach has been recommended for the management of patients with infective endocarditis. We evaluated the impact of multidisciplinary case conferences on morbidity, mortality, and quality of care for these patients.
We conducted a quasi-experimental study of consecutive patients admitted for infective endocarditis before (2013/10/1-2015/10/12, n = 97) and after (2015/10/13-2017/11/30, n = 80) implementation of case conferences to discuss medical and surgical management. These occurred as face-to-face discussions or electronically (for non-complex patients), and included physicians from cardiac surgery, cardiology, critical care, infectious diseases and neurology. We assessed process-of-care and clinical outcomes, with the primary outcome being complications up to 90 days after hospital discharge.
A case conference was held for 80/80 (100%) of patients in the post-intervention group. After the intervention, more patients received inpatient cardiology assessment (81.3% [post-intervention] vs. 63.9% [pre-intervention], p = 0.01), and more patients with definite infective endocarditis underwent cardiac surgery treatment (44.6% vs. 21.7%, p = 0.007). All pre-intervention and post-intervention patients received guideline-concordant antimicrobial therapy. There was no difference in rates of complications (40.0% vs. 51.5%, p = 0.13) or mortality up to 90 days after hospital discharge (26.3% vs. 17.5%, p = 0.20). In multivariable analyses, the intervention was not associated with differences in mortality (odds ratio 1.87, 95% confidence interval 0.88-3.99) or a composite measure of complications and mortality (odds ratio 0.86, 95% confidence interval 0.46-1.58).
We successfully implemented a standardized multidisciplinary case conference protocol for patients with infective endocarditis. This intervention had no detectable effect on complications or mortality.
多学科方法已被推荐用于感染性心内膜炎患者的管理。我们评估了多学科病例会议对这些患者的发病率、死亡率和护理质量的影响。
我们对连续收治的感染性心内膜炎患者进行了一项准实验研究，这些患者分别在实施病例会议之前（2013 年 10 月 1 日至 2015 年 10 月 12 日，n=97）和之后（2015 年 10 月 13 日至 2017 年 11 月 30 日，n=80）进行了病例讨论，以讨论医疗和手术管理。这些病例会议以面对面讨论或电子方式（对于非复杂患者）进行，包括心脏外科、心脏病学、重症监护、传染病学和神经病学方面的医生。我们评估了护理过程和临床结局，主要结局是出院后 90 天内的并发症。
干预组的 80/80（100%）例患者召开了病例会议。干预后，更多的患者接受了住院心脏病学评估（81.3%[干预后] vs. 63.9%[干预前]，p=0.01），更多明确诊断为感染性心内膜炎的患者接受了心脏手术治疗（44.6% vs. 21.7%，p=0.007）。所有干预前和干预后的患者均接受了符合指南的抗菌治疗。出院后 90 天内的并发症发生率（40.0% vs. 51.5%，p=0.13）或死亡率（26.3% vs. 17.5%，p=0.20）无差异。多变量分析显示，该干预措施与死亡率（比值比 1.87，95%置信区间 0.88-3.99）或并发症和死亡率的复合指标（比值比 0.86，95%置信区间 0.46-1.58）均无相关性。
我们成功实施了感染性心内膜炎患者的标准化多学科病例会议方案。该干预措施对并发症或死亡率无明显影响。
