Multidisciplinary teams may not improve outcomes on general medicine wards

1. This systematic review of the effect of a multidisciplinary team intervention on the general medicine ward on objective measures such as length of stay, early readmission rates, and mortality did not show any improvements in any of these outcomes.

2. However, rather than showing the ineffectiveness of multidisciplinary teams, this study instead shows significant heterogeneity in how these teams are utilized, and inconsistencies in studying meaningful outcomes for inpatient medicine care.

Evidence Rating Level: 1 (Excellent) 

Study Rundown: There is much more to the general medical ward than the diagnosis and management of specific disease. The organization of the ward and delivery of care is complex, and there is a major interest in optimizing this for the benefit of patient care. Interdisciplinary care on the wards has been touted to improve objective patient outcomes. This systematic review was conducted to investigate if this was the case. This study showed that multidisciplinary team intervention on the general medicine ward did not have any positive impact on the length of stay, early readmission rates, and mortality. However, rather than showing the ineffectiveness of multidisciplinary teams, this study instead showed significant heterogeneity in how these teams were utilized, and inconsistencies in studying meaningful outcomes for inpatient medicine care.

The strength of the study lies in the extensive review of the literature and the period of time included in the search. However, there were several important limitations. The studies all had somewhat different definitions of the ‘multidisciplinary’ intervention. Also, the studies did have significant biases that were often not corrected, such as correcting for the acuity or mix of cases. Lastly, not all studies included all of the same outcomes.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Improving quality of delirium care in a general medical service with established interdisciplinary care: a controlled trial

In-Depth [systematic review]: The studies that were included in this systematic review came from EMBASE, MEDLINE, and PsychINFO databases from 1998 to 2013. Only studies that examined the effects of interdisciplinary teams on the objective outcomes, such as length of stay, early mortality, and early readmissions, were included in the study. The definitions of “multidisciplinary” did vary between the studies, to include subspecialists, other health care professionals, and modality of rounds, etc.

In 23 of the studies that evaluated length of stay outcomes, 16 (70%) did not identify any significant change, and only 5 of 23 (22%) showed decrease in length of stay with the multidisciplinary intervention. In regards to early readmission rates, different forms of intervention teams (infectious disease subspecialists, pharmacists, etc) also did not show any decreases in readmission. Lastly, in regards to mortality rates, only one of the 15 studies (7%) that measured this outcome was able to show a significant decrease.

Image: PD

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