Sreepathy Pranati, Kim Yoo Jin, Ahuja Zaneta, Shroff Adhir R, Nazir Noreen T
Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States.
The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States.
Front Cardiovasc Med. 2022 Nov 4;9:1005150. doi: 10.3389/fcvm.2022.1005150. eCollection 2022.
Multidisciplinary rounds (MDR) consisting of social workers, dietitians, pharmacists, physical therapists, nurses, and physicians have been implemented at many healthcare institutions to address the complex components of inpatient care. However, little is known on the association of MDR on clinical outcomes across cardiovascular pathologies. This study aimed to investigate the impact of MDR on cardiovascular patients.
Hospital admissions to inpatient cardiology were evaluated prior to (November 2017 to November 2018) and after implementation of MDR (December 2018 to August 2020) at a metropolitan academic medical center. The following outcomes were evaluated: clinical complications (incidence of stroke, gastrointestinal bleed, myocardial infarction, or systemic infection during hospitalization), Length of Stay (LOS), 30-day readmissions and all-cause in-hospital mortality. Secondary outcomes included utilization of physical therapy and dietary services.
Admissions were evaluated prior to ( = 1054) and after ( = 1659) MDR implementation. All-cause in-hospital mortality after MDR implementation decreased significantly from 2.8 to 1.6% ( = 0.03). Although the number of complications and LOS decreased, these differences were not statistically significant. No significant change was observed in 30-day readmissions. Significant increase in the utilization of physical therapy (34.2 to 53.5%; < 0.01) and dietary services (7.2 to 19.3%; < 0.01) were observed.
Multidisciplinary rounds implementation was associated with significantly decreased mortality and positively impacted resource utilization with increased consultations for ancillary services. MDR is a high impact intervention that utilizes existing resources to improve mortality and should be implemented especially for cardiovascular patients. Further investigation into the benefit of MDR across different patient populations and care settings is warranted.
许多医疗机构已开展由社会工作者、营养师、药剂师、物理治疗师、护士和医生组成的多学科会诊（MDR），以解决住院治疗的复杂问题。然而，关于MDR与心血管疾病临床结局之间的关联，人们知之甚少。本研究旨在调查MDR对心血管疾病患者的影响。
在一家大都市学术医疗中心，对2017年11月至2018年11月（MDR实施前）和2018年12月至2020年8月（MDR实施后）期间的住院心脏病患者入院情况进行评估。评估以下结局：临床并发症（住院期间中风、胃肠道出血、心肌梗死或全身感染的发生率）、住院时间（LOS）、30天再入院率和全因院内死亡率。次要结局包括物理治疗和饮食服务的使用情况。
对MDR实施前（n = 1054）和实施后（n = 1659）的入院情况进行评估。MDR实施后，全因院内死亡率从2.8%显著降至1.6%（P = 0.03）。虽然并发症数量和LOS有所下降，但这些差异无统计学意义。30天再入院率无显著变化。观察到物理治疗的使用显著增加（从34.2%增至53.5%；P < 0.01），饮食服务的使用也显著增加（从7.2%增至19.3%；P < 0.01）。
多学科会诊的实施与死亡率显著降低相关，并对资源利用产生积极影响，辅助服务的会诊增加。MDR是一种利用现有资源改善死亡率的高影响力干预措施，尤其应针对心血管疾病患者实施。有必要进一步研究MDR在不同患者群体和护理环境中的益处。
