The impact of consultant-delivered multidisciplinary inpatient medical care on patient outcomes

Editor – We read with interest the article by Fielding et al which assessed the impact of consultant-led multidisciplinary team (MDT)-delivered care on length of stay (Clin Med August 2013 p344–8). Taken together with the earlier study by Ahmad et al,¹ there appears to be mounting support that increasing consultant-delivered ward rounds is associated with shorter length of stay. However, at our own institution we found that the introduction of two extra consultant ‘winter pressure’ ward rounds by the respiratory and general internal medicine (GIM) teams was associated with only a very modest saving in average length of stay when compared to the non-respiratory/GIM teams, who continued with two formal ward rounds per week (Table 1). Furthermore, an earlier start time of 8am did not appear to influence the time of TTO (‘to take out’ prescription) printing or the time of discharge.

While the data presented by Fielding et al are encouraging, we urge caution before widespread implementation of daily consultant-delivered care. As stated in the conclusion, their study was not a randomised controlled trial (RCT) and is open to considerable selection bias. Furthermore, they do not include a formal health economic analysis in their report, nor do they comment on the experience of the consultants concerned in terms of the sustainability of such high intensity work.

Despite the strongly worded conclusion of the Academy of Royal Colleges report² recommending daily consultant-delivered care, to our knowledge there have been no RCTs performed in this area. The cost of employing sufficient consultants to deliver a consultant-led ward service will be substantial and persuading new consultants to sign up to delivering care without trainees will be challenging. While we support the concept of early and regular patient access to senior clinical decision makers, we advocate the collection of more robust data before the widespread introduction of daily consultant delivered care on general medical wards.

• © 2013 Royal College of Physicians