Safety in Numbers


A report that associates lower ICU mortality rates with multidisciplinary team rounding has one thought leader envisioning hospitalists as a key part of future collaborations.

The Feb. 22 study, "The Effect of Multidisciplinary Care Teams on Intensive Care Unit Mortality," included 107,324 patients at 112 hospitals (Arch Intern Med. 2010;170(4):369-376). Overall 30-day mortality was 18.3%. After making adjustments for patient and hospital characteristics, the team reported that multidisciplinary care was associated with significant reductions in the odds of death (odds ratio [OR], 0.84%; 95% confidence interval [CI], 0.76-0.93 [P=0.01]).

J. Perren Cobb, MD, of Massachusetts General Hospital in Boston wrote an accompanying editorial calling for physicians to see quality improvement (QI) projects tied to collaborative care as stepping stones to what he calls "health engineering." He defines the term as the "application of systems science to study how staff, patient, data, and equipment interactions can be engineered to optimize patient outcomes."

Dr. Cobb explains, for example, that hospitalists and intensivists can provide 24/7 care. "Hospitalists can bridge the care of the patient from the ICU to the non-ICU setting," he says.

Dr. Cobb wants competing factions in hospitals to share a "common vision" that studies patient care from both macro and micro perspectives. That encompasses everything from patient handoffs that require brief conversations between shifts to streamlining electronic medical records. His editorial focuses on the potential improvements in ICUs, but he notes that the "engineering of healthcare" can improve efficiency and efficacy across the continuum of care.

"The components are all there; they’ve been there for a long time," Dr. Cobb adds. "But what we're seeing in medicine is we’re evolving from 'seeing one patient at a time' to managing systems."

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