Impact of multidisciplinary cardiology rounds on a cardiac ICU: a prospective cohort study

Introduction

Quality improvement is an important activity for all members of an interdisciplinary cardiology critical care team.

Objective

To evaluate whether multidisciplinary quality improvement in cardiac critical care, focused on a daily routine of rounds, protocol standardizations, and under the leadership of the same attending cardiologist in charge of coordinating a team, could produce better outcomes and resource utilization.

Methods

Prospectively collected data for consecutive patients who were admitted to a nine-bed cardiac intensive care unit (CICU) in two periods: January-June 2013 and January-June 2014. In the first period (control group) the patients were evaluated by common CICU routine, each day attended by a different intensivist physician, with no standardization of the multidisciplinary approach. Between the two periods there was a 6-month multidisciplinary training. In the second period (intervention group) the same cardiologist and multidisciplinary team made the daily routine rounds, with standardizations of managements and evidence-based care. Demographics and outcomes (mortality, time of ICU stay and mechanical ventilation time) were compared.

Results

A total of 610 patients were evaluated in the period of the study, 314 (51.4%) in the control group and 296 (48.6%) in the intervention group. Both groups were well matched for demographics: intervention and control group respectively, mean age of 68.9 (±14.7) vs. 70.9 (±13.2), p = 0.08; admission after cardiac surgery 21 (7.1%) vs. 26 (8.3%), p = 0.40; admission after percutaneous interventions 60 (20.3%) vs. 59 (18.8%), p = 0.55. The mean predicted mortality assessed by the simplified acute physiology score 3 (SAPS-3) and the Charlson comorbidity index were similar in both groups: intervention and control respectively, 43.1 (±13.1) vs. 42.8 (±12.9), p = 0.66 and 1.91 (±2.1) vs. 1.90 (±2.2), p = 0.97. Despite this, the mean ICU stay was lower in the intervention group as compared with the control group, 2.5 (±3.4) vs. 3.4 (±3.8) days, p = 0.003; as was the mean mechanical ventilation time 0.84 (±0.16) vs. 4.16 (±1.47), p = 0.005. The 30-day mortality was 11 (3.7%) vs. 15 (4.7%), RR 0.79, 95% CI 0.64-3.03, p = 0.40. After multivariate analysis, there were no changes in the results.

Conclusion

A focused cardiac critical care management on a CICU, based on a multidisciplinary approach and daily rounds performed by the same cardiologist, reduced the CICU stay and mechanical ventilation time, with the same mortality rates. This action could help improve resource utilization.