The association between implementation of multidisciplinary rounds and clinical outcomes

Pranati Sreepathy; Yoo Jin Kim; Zaneta Ahuja; Adhir R Shroff; Noreen T Nazir

doi:10.3389/fcvm.2022.1005150

The association between implementation of multidisciplinary rounds and clinical outcomes

Front Cardiovasc Med. 2022 Nov 4:9:1005150. doi: 10.3389/fcvm.2022.1005150. eCollection 2022.

Authors

Pranati Sreepathy¹, Yoo Jin Kim^{2

3}, Zaneta Ahuja⁴, Adhir R Shroff⁵, Noreen T Nazir⁵

Affiliations

¹ Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States.
² The Johns Hopkins Hospital, Johns Hopkins Medicine, Baltimore, MD, United States.
³ College of Medicine, University of Illinois at Chicago, Chicago, IL, United States.
⁴ Health Sciences System, University of Illinois Hospital, Chicago, IL, United States.
⁵ Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States.

Abstract

Background: 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.

Methods: 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.

Results: Admissions were evaluated prior to (N = 1054) and after (N = 1659) MDR implementation. All-cause in-hospital mortality after MDR implementation decreased significantly from 2.8 to 1.6% (P = 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%; P < 0.01) and dietary services (7.2 to 19.3%; P < 0.01) were observed.

Conclusion: 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.

Keywords: cardiovascular care and outcomes; cardiovascular care coordination; care strategies; mortality benefit; multidisciplinary team.