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Controlled trial of multidisciplinary care teams for acutely ill medical inpatients: enhanced multidisciplinary care
Author(s) -
Mudge A.,
Laracy S.,
Richter K.,
Denaro C.
Publication year - 2006
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2006.01135.x
Subject(s) - medicine , multidisciplinary approach , staffing , referral , health care , intervention (counseling) , hospital medicine , emergency medicine , medical emergency , nursing , family medicine , social science , sociology , economics , economic growth
Background: Acute hospital general medicine services care for ageing complex patients, using the skills of a range of health‐care providers. Evidence suggests that comprehensive early assessment and discharge planning may improve efficiency and outcomes of care in older medical patients. Aim: To enhance assessment, communication, care and discharge planning by restructuring consistent, patient‐centred multidisciplinary teams in a general medicine service. Methods: Prospective controlled trial enrolling 1538 consecutive medical inpatients. Intervention units with additional allied health staff formed consistent multidisciplinary teams aligned with inpatient admitting units rather than wards; implemented improved communication processes for early information collection and sharing between disciplines; and specified shared explicit discharge goals. Control units continued traditional, referral‐based multidisciplinary models with existing staffing levels. Results: Access to allied health services was significantly enhanced. There was a trend to reduced index length of stay in the intervention units (7.3 days vs 7.8 days in control units, P = 0.18), with no change in 6‐month readmissions. In‐hospital mortality was reduced from 6.4 to 3.9% ( P = 0.03); less patients experienced functional decline in hospital ( P = 0.04) and patients’ ratings of health status improved ( P = 0.02). Additional staffing costs were balanced by potential bed‐day savings. Conclusion: This model of enhanced multidisciplinary inpatient care has provided sustainable efficiency gains for the hospital and improved patient outcomes.