New Model of Intensive Care Breathing Specialists Working with Heart Doctors Is Promising, Study Reports

Doctors who are intensive care respiratory specialists help seriously ill heart patients with breathing difficulties achieve better outcomes, a University of Maryland School of Medicine study reports.

Researchers said the new model of having these specialists work with cardiac specialists also lowers patients’ costs. One reason the model works is that the intensive care specialists also have cardiac training.

The intensive care specialists, whom the researchers dubbed intensivists, helped patients who were receiving mechanical breathing assistance in the University of Maryland Medical Center’s intensive care unit. Some of the patients had pulmonary hypertension.

Intensivists helped improve patients’ treatment, decreased the time they stayed in the hospital, and lowered their treatment costs, the study found.

Researchers published the results in the Journal of the American College of Cardiology in an article titled “A Collaborative Cardiologist-Intensivist Management Model Improves Cardiac Intensive Care Unit Outcomes.”

“When we looked at the clinical results of our intervention, we were removing the breathing tube faster and getting patients out of the Cardiac ICU about two days earlier than previously,” Michael T. McCurdy, an associate professor at the medical school, said in a press release.

“Plus, we saved well over $4 million a year in hospital costs. It was striking,” added McCurdy, the senior author of the study.

Researchers looked at patients’ records from a year before the intensivist program started to a year afterward. The study involved two groups. One hundred sixty-two were in the pre-implementation group and 201 in the post-implementation group. All 363 patients received mechanical ventilation in the intensive care unit.

The team analyzed how long patients were in the hospital, if they had met a benchmark of 28 days of unassisted breathing, the costs of both hospitalization and length of stay, and how many deaths occurred in the hospital.

The key finding of the study was the direct benefit to patients, McCurdy stressed. “The number of patients discharged to home from the CICU rose significantly, from 27 percent to 42 percent,” he said.

Discussing possible next steps in the use of physicians trained in both critical care medicine and cardiology, the medical center’s Gautam V. Ramani, said: “It’s difficult to find these people. It’s a new area, a new field. Not many people have dual certification, but there is increasing recognition that this collaborative approach can reduce the length of stay and improve patient outcomes.

“This is a developing paradigm — critical care medicine-trained physicians working collaboratively with cardiologists” in a cardiac intensive care unit,  said Ramani, director of the medical center’s advanced heart failure program, and a co-author of the study. “The take-home message: There is a role for a collaborative model between critical care and cardiac care.”