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Case AS, Hochberg CH, Hager DN. The Role of Intermediate Care in Supporting Critically Ill Patients and Critical Care Infrastructure. Crit Care Clin 2024; 40:507-522. [PMID: 38796224 DOI: 10.1016/j.ccc.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
Intermediate care (IC) is used for patients who do not require the human and technological support of the intensive care unit (ICU) yet require more care and monitoring than can be provided on general wards. Though prevalent in many countries, there is marked variability in models of organization and staffing, as well as monitoring and interventions provided. In this article, the authors will discuss the historical background of IC, review the impact of IC on ICU and IC patient outcomes, and highlight where future studies can shed light on how to optimize IC organization and outcomes.
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Affiliation(s)
- Aaron S Case
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 East Monument Street, 5th Floor, Baltimore, MD 21287, USA
| | - Chad H Hochberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1830 East Monument Street, 5th Floor, Baltimore, MD 21287, USA
| | - David N Hager
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 1800 Orleans Street, Zayed Tower, Suite 9121, Baltimore, MD 21287, USA.
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Terwilliger IA, Johnson JK, Manojlovich M, Astik GJ, Kim JS, Williams MV, O'Leary KJ. Contextual Factors Influencing the Implementation of a Multifaceted Intervention to Improve Teamwork and Quality for Hospitalized Patients: A Multisite Qualitative Comparative Case Study. Jt Comm J Qual Patient Saf 2024; 50:193-201. [PMID: 37838603 DOI: 10.1016/j.jcjq.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Many hospitals have begun to implement models that combine interventions to redesign care for medical patients. These models include localization of physicians to specific units, nurse-physician co-leadership, and interprofessional rounds. Understanding contextual factors, the circumstances surrounding an implementation effort that influence its success, is essential to provide guidance to leaders implementing similar models of care. METHODS A multisite qualitative comparative case study was conducted with four hospitals in the REdesigning SystEms to Improve Teamwork and Quality for Hospitalized Patients (RESET) study. Researchers conducted observations and semistructured interviews with 40 health care professionals and four implementation mentors. Researchers used inductive qualitative content analysis, reviewed fidelity of implementation trends, and performed cross-case analysis to identify contextual factors and their influence on implementation. RESULTS Four contextual factors were associated with implementation success: (1) senior hospital leader involvement and organizational support; (2) alignment of RESET with organizational, hospital, and professional group priorities; (3) site leaders' engagement in RESET and relationship with one another; and (4) perceptions of need and intervention benefits among professionals. Implementation was optimal when senior leadership was stable and tangibly involved; organizational, hospital, and group goals were aligned; site leaders were committed and collaborated well; and nurses and physicians perceived a need for and benefits from the interventions. CONCLUSION Four interrelated contextual factors are associated with the implementation of combined interventions to redesign care for hospitalized medical patients. Hospital leaders should consider these findings prior to implementing similar interventions and be prepared to address challenges related to these factors during implementation.
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O'Leary KJ, Johnson JK, Williams MV, Estrella R, Hanrahan K, Leykum LK, Smith GR, Goldstein JD, Kim JS, Thompson S, Terwilliger I, Song J, Lee J, Manojlovich M. Effect of Complementary Interventions to Redesign Care on Teamwork and Quality for Hospitalized Medical Patients : A Pragmatic Controlled Trial. Ann Intern Med 2023; 176:1456-1464. [PMID: 37903367 DOI: 10.7326/m23-0953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Multiple challenges impede interprofessional teamwork and the provision of high-quality care to hospitalized patients. OBJECTIVE To evaluate the effect of interventions to redesign hospital care delivery on teamwork and patient outcomes. DESIGN Pragmatic controlled trial. Hospitals selected 1 unit for implementation of interventions and a second to serve as a control. (ClinicalTrials.gov: NCT03745677). SETTING Medical units at 4 U.S. hospitals. PARTICIPANTS Health care professionals and hospitalized medical patients. INTERVENTION Mentored implementation of unit-based physician teams, unit nurse-physician coleadership, enhanced interprofessional rounds, unit-level performance reports, and patient engagement activities. MEASUREMENTS Primary outcomes were teamwork climate among health care professionals and adverse events experienced by patients. Secondary outcomes were length of stay (LOS), 30-day readmissions, and patient experience. Difference-in-differences (DID) analyses of patient outcomes compared intervention versus control units before and after implementation of interventions. RESULTS Among 155 professionals who completed pre- and postintervention surveys, the median teamwork climate score was higher after than before the intervention only for nurses (n = 77) (median score, 88.0 [IQR, 77.0 to 91.0] vs. 80.0 [IQR, 70.0 to 89.0]; P = 0.022). Among 3773 patients, a greater percentage had at least 1 adverse event after compared with before the intervention on control units (change, 1.61 percentage points [95% CI, 0.01 to 3.22 percentage points]). A similar percentage of patients had at least 1 adverse event after compared with before the intervention on intervention units (change, 0.43 percentage point [CI, -1.25 to 2.12 percentage points]). A DID analysis of adverse events did not show a significant difference in change (adjusted DID, -0.92 percentage point [CI, -2.49 to 0.64 percentage point]; P = 0.25). Similarly, there were no differences in LOS, readmissions, or patient experience. LIMITATION Adverse events occurred less frequently than anticipated, limiting statistical power. CONCLUSION Despite improved teamwork climate among nurses, interventions to redesign care for hospitalized patients were not associated with improved patient outcomes. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (K.J.O., G.R.S., J.S.K.)
| | - Julie K Johnson
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois (J.K.J.)
| | - Mark V Williams
- Division of Hospital Medicine, Washington University School of Medicine, St. Louis, Missouri (M.V.W.)
| | | | | | - Luci K Leykum
- Department of Medicine, University of Texas at Austin Dell Medical School, Austin, and South Texas Veterans Health Care System, San Antonio, Texas (L.K.L.)
| | - G Randy Smith
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (K.J.O., G.R.S., J.S.K.)
| | - Jenna D Goldstein
- Society of Hospital Medicine, Philadelphia, Pennsylvania (J.D.G., S.T.)
| | - Jane S Kim
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (K.J.O., G.R.S., J.S.K.)
| | - Sara Thompson
- Society of Hospital Medicine, Philadelphia, Pennsylvania (J.D.G., S.T.)
| | - Iva Terwilliger
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois (I.T.)
| | - Jing Song
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois (J.S., J.L.)
| | - Jungwha Lee
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois (J.S., J.L.)
| | - Milisa Manojlovich
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan (M.M.)
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Maxey J, Gupta A, Houchens N. Quality and safety in the literature: April 2023. BMJ Qual Saf 2023; 32:235-240. [PMID: 36931631 DOI: 10.1136/bmjqs-2023-015977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Jordan Maxey
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ashwin Gupta
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Jenkins AM, Weber DE, Arfaa JJE, Arken A, Clark DL, Dobbs E, Lahbabi B, Myers K, Tu J, Clarke-Myers K. Using participatory research to identify actionable facilitators and barriers to effective inpatient interdisciplinary communication. J Hosp Med 2023; 18:130-138. [PMID: 36448186 DOI: 10.1002/jhm.13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Communication failures occur often in the inpatient setting. Efforts to understand and improve communication often exclude patients or are siloed by discipline. OBJECTIVE We aimed to identify barriers and facilitators to effective communication within interdisciplinary inpatient internal medicine (IM) teams using a participatory research approach. DESIGN We conducted a single-center participatory mixed methods study using group-level assessment (GLA) and concept mapping to iteratively engage stakeholders. Stakeholder groups included patients/families, IM faculty, IM residents, nurses and ancillary staff, and care managers. Stakeholder-specific GLA sessions were conducted. Participants responded to prompts addressing interdisciplinary communication then worked in small groups to synthesize the qualitative data into unique ideas. A subset of each stakeholder group then sorted ideas through a concept mapping exercise. Multidimensional scaling and hierarchical cluster analysis were used to generate a concept map of the data. RESULTS Participants generated 97 unique ideas that were then sorted. The research team chose an eight-cluster concept map representing patient inclusion and engagement, processes and resources, team morale and inclusive dynamics, attitudes and behaviors, effective communication, barriers to communication, the culture of healthcare, and clear expectations. Three larger domains of patient inclusion and engagement, organizational conditions and role clarity, and team dynamics and behaviors were noted. CONCLUSION Use of a participatory research approach made it feasible to engage diverse stakeholders including patients. Our results highlight the need to identify context-specific facilitators and barriers of interdisciplinary communication. The importance of clear expectations was identified as a prioritized area to target communication improvement efforts.
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Affiliation(s)
- Ashley M Jenkins
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Danielle E Weber
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | - Danielle L Clark
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Emily Dobbs
- Department of Biology, Northern Kentucky University, Highland Heights, Kentucky, USA
| | - Betina Lahbabi
- University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Kurt Myers
- University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Jamie Tu
- University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Katherine Clarke-Myers
- Quality and Value, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Iyasere CA, Wing J, Martel JN, Healy MG, Park YS, Finn KM. Effect of Increased Interprofessional Familiarity on Team Performance, Communication, and Psychological Safety on Inpatient Medical Teams: A Randomized Clinical Trial. JAMA Intern Med 2022; 182:1190-1198. [PMID: 36215043 PMCID: PMC9552049 DOI: 10.1001/jamainternmed.2022.4373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/06/2022] [Indexed: 12/14/2022]
Abstract
Importance In large academic centers, medical residents work on multiple clinical floors with transient interactions with nursing colleagues. Although teamwork is critical in delivering high-quality medical care, little research has evaluated the effect of interprofessional familiarity on inpatient team performance. Objective To determine the effectiveness of increased familiarity between medical residents and nurses on team performance, psychological safety, and communication. Design, Setting, and Participants A 12-month randomized clinical trial in an inpatient general medical service at a large academic medical center was completed from June 25, 2019, to June 24, 2020. Participants included 33 postgraduate year (PGY)-1 residents in an internal medicine residency program and 91 general medicine nurses. Interventions Fifteen PGY-1 residents were randomized to complete all 16 weeks of their general medicine inpatient time on 1 medical nursing floor (intervention group with 43 nurses). Eighteen PGY-1 residents completed 16 weeks on 4 different general medical floors as per usual care (control group with 48 nurses). Main Outcomes and Measures The primary outcome was an assessment of team performance in physician-nurse simulation scenarios completed at 6 and 12 months. Interprofessional communication was assessed via a time-motion study of both work rounds and individual resident clinical work. Psychological safety and teamwork culture were assessed via surveys of both residents and nurses at multiple time points. Results Of the intervention and control PGY-1 residents, 8 of 15 (54%) and 8 of 18 (44%) were women, respectively. Of the nurses in the intervention and control groups with information available, 37 of 40 (93%) and 34 of 38 (90%) were women, respectively, and more than 70% had less than 10 years of clinical experience. There was no difference in overall team performance during the first simulation. At the 12-month simulation, the intervention teams received a higher mean overall score in leadership and management (mean [SD], 2.47 [0.53] vs 2.17 [0.39]; P = .045, Cohen d = 0.65) and on individually rated items were more likely to work as 1 unit (100% vs 62%; P = .003), negotiate with the patient (61% vs 10%; P = .001), support other team members (61% vs 24%; P = .02), and communicate as a team (56% vs 19%; P = .02). The intervention teams were more successful in achieving the correct simulation case outcome of negotiating a specific insulin dose with the patient (67% vs 14%; P = .001). Time-motion analysis noted intervention teams were more likely to have a nurse present on work rounds (47% vs 28%; P = .03). At 6 months, nurses in the intervention group were more likely to report their relationship with PGY-1 residents to be excellent to outstanding (74% vs 40%; P = .003), feel that the input of all clinical practitioners was valued (95% vs 53%; P < .001), and say that feedback between practitioners was delivered in a way to promote positive interactions (90% vs 60%; P = .003). These differences diminished at the 12-month survey. Conclusions and Relevance In this randomized clinical trial, increased familiarity between nurses and residents promoted more rapid improvement of nursing perception of team relationships and, over time, led to higher team performance on complex cognitive tasks in medical simulations. Medical centers should consider team familiarity as a potential metric to improve physician-nursing teamwork and patient care. Trial Registration ClinicalTrials.gov Identifier: NCT05213117.
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Affiliation(s)
- Christiana A. Iyasere
- Department of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Wing
- Department of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - J. Naomi Martel
- General Medicine Unit at Massachusetts General Hospital, Boston
| | - Michael G. Healy
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Yoon Soo Park
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Kathleen M. Finn
- Department of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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Kato H, Clouser JM, Talari P, Vundi NL, Adu AK, Karri K, Isaacs KB, Williams MV, Chadha R, Li J. Bedside Nurses' Perceptions of Effective Nurse-Physician Communication in General Medical Units: A Qualitative Study. Cureus 2022; 14:e25304. [PMID: 35774666 PMCID: PMC9236637 DOI: 10.7759/cureus.25304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/06/2022] Open
Abstract
Background There is a dearth of research on successful interventions to improve nurse-physician communication (NPC). An important step is identifying what matters to bedside nurses and their perceptions of effective NPC communications and actions. Methods We conducted three focus groups with a total of 19 medical unit nurses across two hospitals in one academic medical center in the United States. Using a convenience sampling strategy, five to eight nurses voluntarily participated in each focus group. The recording was transcribed verbatim and two independent coders performed coding and resolved any discrepancies in codes. Qualitative content analysis was pursued to identify themes and associated quotes. Results The presence of direct communication between physicians and nurses was identified as the first theme and perceived by nurses as very important. Additional themes related to physician communication and attributes emerged including collegiality and respect (e.g., engaging nurses as partners in patient care), attentiveness and responsiveness (e.g., listening carefully and addressing concerns), and directness and support (e.g., backing nurses up in difficult situations). Effective NPC is further facilitated by organizational structure, relationship development separate from patient care, and consistent/timely use of technology. Conclusions Hospital bedside nurses provided valuable insight into improved physician communication and what attributes contribute to more effective NPC. Most importantly, they emphasized the significance of physicians in supporting them with difficult patients.
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Cyrus RM, Kulkarni N, Astik G, Weaver C, Hanrahan K, Malladi M, O'Sullivan P, O'Leary KJ. Effect of an Attending Nurse on Timeliness of Discharge, Patient Satisfaction, and Readmission. J Nurs Manag 2022; 30:2023-2030. [PMID: 35476274 DOI: 10.1111/jonm.13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 03/03/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
AIMS To improve the timeliness and quality of discharge for patients by creating the role of the Attending Nurse. BACKGROUND Discharge time affects hospital throughput and patient satisfaction. Bedside nurses and hospitalists have competing priorities that can hinder performing timely, high quality discharges. METHODS This retrospective analysis evaluated the effect of an Attending Nurse paired with a hospital medicine physician on discharge time and quality. A total of 8329 patient discharges were eligible for the study and propensity score matching yielded 2715 matched pairs. RESULTS In the post- intervention matched cohort, the percentage of patients discharged before 2pm increased from 34.4% to 45.9% (p <0.01) and the median discharge time moved 48 minutes earlier. In the unmatched cohort, patient satisfaction with the discharge process improved on several questions. While length of stay was not affected, the 30-day readmission rate did increase from 8.9% to 10.7% (p=0.02). CONCLUSION With the new Attending Nurse role, we positively impacted throughput by shifting discharge times earlier in the day while improving patient satisfaction Length of stay stayed the same but the 30-day readmission rate increased. IMPLICATIONS FOR NURSING MANAGEMENT Our multidisciplinary approach to the problem of late discharge times led to the creation of a new role. This role made ownership of discharge tasks clear and reduced competing priorities, freeing up nurses and hospitalists to perform other care related responsibilities without holding up discharges.
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Affiliation(s)
- Rachel M Cyrus
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - N Kulkarni
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - G Astik
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - C Weaver
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - K Hanrahan
- Northwestern Memorial Hospital, Chicago, IL
| | - M Malladi
- Northwestern Memorial Hospital, Chicago, IL
| | | | - Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Carlson KJ, Matthias TH, Birge JR, Bulian BP, Richards SE, Shiffermiller JF. The effect of geographic rounding on hospitalist work experience: A mixed-methods study. Hosp Pract (1995) 2022; 50:124-131. [PMID: 35253585 DOI: 10.1080/21548331.2022.2050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe the structure and implementation of a model in which hospitalists focus on a particular hospital unit or area, referred to as "geographic rounding," and to analyze its effect on hospitalist efficiency, interruptions, after-hours work, and satisfaction. METHODS The leadership of our academic hospital medicine group designed a geographic rounding intervention with the goal of improving provider satisfaction and mitigating burnout. Our quantitative analysis compared the pre-intervention and post-intervention time periods with regard to progress note completion time, after-hours progress note completion, secure messaging communication volume, and Mini-Z survey results. A post-intervention qualitative analysis was performed to further explore the relationship between geographic rounding and the drivers of burnout. RESULTS Following the intervention, 97% of geographic rounders were localized to one or two geographic areas and 77% were localized to a single geographic area. Following the implementation of geographic rounding, progress notes were completed an average of 29 minutes earlier (p<0.001). The proportion of progress notes completed after-hours decreased from 25.1% to 20% (p<0.001). The volume of secure messages received by hospitalists decreased from 1.95 to 1.8 per patient per day (p<0.001). The proportion of hospitalists reporting no burnout increased from 77.8% to 93% after implementing geographic rounding, a change that did not reach statistical significance (p=0.1). Qualitative analysis revealed mixed effects on work environment but improvements in efficiency, patient-centeredness, communication with nurses, and job satisfaction. CONCLUSION Geographic rounding represents an organization-level change that has the potential to improve hospitalist career satisfaction.
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Affiliation(s)
- Kristy J Carlson
- Univeristy of Nebraska Medical Center, Department of Otolaryngology Head and Neck Surgery, 981225 Nebraska Medical Center, Omaha, NE 68198-1225
| | - Tabatha H Matthias
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
| | - Justin R Birge
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
| | - Brady P Bulian
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
| | - Sarah E Richards
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
| | - Jason F Shiffermiller
- Univeristy of Nebraska Medical Center, Department of Internal Medicine, Division of Hospital Medicine, 986435 Nebraska Medical Center, Omaha, NE 68198-6435, USA
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Hathaway JR, Tarini BA, Banerjee S, Smolkin CO, Koos JA, Pati S. Healthcare team communication training in the United States: A scoping review. HEALTH COMMUNICATION 2022:1-26. [PMID: 35168467 DOI: 10.1080/10410236.2022.2036439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The purpose of this literature review was to identify interventions designed to improve healthcare team communication in the United States. We conducted a review of peer-reviewed, English-language articles describing interventions aimed at improving healthcare team communication. We analyzed articles that met pre-specified inclusion and exclusion criteria and characterized who is testing communication interventions, the rationale for testing, and ways of measuring effectiveness. We descriptively categorized the strength and types of study findings. Thirty articles were retained in our analysis. Most assessments were conducted by academic medical centers, the Veterans Health Administration, and teaching hospitals. Interventions sought to improve teamwork, patient safety, clinical outcomes, costs of care, and enhance provider job satisfaction and well-being. Intervention strategies included didactic lectures, simulation, Crew Resource Management, quality improvement, or a combination of these approaches. The vast majority employed a pre-post survey design and measured outcomes using participant feedback. Many assessments failed to utilize a social science theory or communication-specific measures. Interventions with the best training content were conducted at academic medical centers, used a pre-post design, and utilized statistical analysis to analyze results. While interventions for improving healthcare team communication are diverse and have uneven effectiveness, early markers of success merit continued development and assessment.
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Affiliation(s)
- Julia R Hathaway
- Alan Alda Center for Communicating Science®, Stony Brook University
| | - Beth A Tarini
- Center for Translational Research, Children's National Medical Center
| | - Sushmita Banerjee
- Renaissance School of Medicine, Stony Brook University, Stony Brook University
| | - Caroline O Smolkin
- Renaissance School of Medicine, Stony Brook University, Stony Brook University
| | | | - Susmita Pati
- Alan Alda Center for Communicating Science®, Renaissance School of Medicine at Stony Brook University & Stony Brook Children's Hospital, Stony Brook University
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11
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Hager DN, Dezube R, Disney SM, Flanagan E, Huang S, Kakadiya K, Langlotz R, Lautzenheiser MB, Street L, Michalek A, Biddison LD, Desai SV, Herzke CA. Models of Intermediate Care Organization and Staffing at an Academic Medical Center: Considerations of an Inpatient Planning Committee. J Intensive Care Med 2022; 37:1288-1295. [DOI: 10.1177/08850666211062151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rationale: Geographic co-localization of patients and provider teams (geography) may improve care efficiency and quality. Patients requiring intermediate care present a unique challenge to the geographic model. Objective: Identify the best organizational and staffing model for intermediate care at our academic medical center. Methods: A modified nominal group technique was employed to assess the benefits and limitations of an existing model of intermediate care, identify and review potential alternative models, and choose a new model. Results: In addition to the institution's current model, the benefits and limitations of six alternative organizational and staffing models were characterized. The anticipated impact of each model on nurse: provider communication, maintenance of nursing competencies, nurse satisfaction, efficient utilization of technical and human resources, triage of patients to the unit, care continuity, and the impact on trainee education are described. After considering these features, stakeholders ranked a closed provider staffing model on a unit dedicated to intermediate care highest of the six alternative models. Important outcomes to monitor following transition to a closed staffing model included patient outcomes, nursing job satisfaction and retention, provider and trainee experience, unexpected patient transfers to higher or lower levels of care, and administrative costs. Conclusions: After considering six alternative staffing models for intermediate care, stakeholders ranked a closed provider staffing model highest. Further qualitative and quantitative comparisons to determine optimal models of intermediate care are needed.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lara Street
- Johns Hopkins University, Baltimore, MD, USA
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12
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Kohn R, Makam AN. Are disruptions to geographic cohorting safe? J Hosp Med 2022; 17:69-70. [PMID: 35504584 DOI: 10.1002/jhm.2739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Rachel Kohn
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anil N Makam
- Division of Hospital Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA
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Manojlovich M, Hofer TP, Krein SL. Advancing Patient Safety Through the Clinical Application of a Framework Focused on Communication. J Patient Saf 2021; 17:e732-e737. [PMID: 30383622 DOI: 10.1097/pts.0000000000000547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study of communication has evolved from diverse academic disciplines, yet those diverse fields are not well represented in theoretical frameworks that describe communication in health care, narrowing our ability to explain how communication affects patient safety. The purpose of this review article is to describe a conceptual framework of communication drawn from multiple academic disciplines and apply it to health care, specifically for examining communication between providers about the clinical care of their patients. METHODS A seminal article in the field of communication that attempted to map the entire field of communication theory inspired our conceptual framework. We adapted these concepts, largely from the social science literature, to find alternative ways of conceptualizing communication and ways to enhance communication in health care. RESULTS There are 8 theoretical traditions that informed our conceptual framework: rhetorical, phenomenological, semiotic, cybernetic, sociopsychological, sociocultural, critical, and pragmatic. We provide practical, clinical applications of our conceptual framework, encompassing the interpersonal nature of communication, relationship building and trust, hierarchical differences, and the role of technology in communication. In adopting our conceptual framework, we suggest that researchers and clinicians can choose from any combination of these 8 theoretical traditions to more fully describe and ultimately enhance communication-related phenomena. CONCLUSIONS Poor communication remains a stubborn problem in health care in part because of a narrow theoretical and definitional approach to resolving it. Our conceptual framework suggests ways to build relationships and trust, addresses hierarchical differences between communicators, and illuminates the role of technology in communication. It also importantly expands the definition of the value of communication beyond simple information exchange to include creation of new knowledge during communication through the development of shared understanding.
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Ratelle JT, Herberts M, Miller D, Kumbamu A, Lawson D, Polley E, Beckman TJ. Relationships Between Time-at-Bedside During Hospital Ward Rounds, Clinician-Patient Agreement, and Patient Experience. J Patient Exp 2021; 8:23743735211008303. [PMID: 34179432 PMCID: PMC8205390 DOI: 10.1177/23743735211008303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Hospital medicine ward rounds are often conducted away from patients’ bedsides,
but it is unknown if more time-at-bedside is associated with improved patient
outcomes. Our objective is to measure the association between “time-at-bedside,”
patient experience, and patient–clinician care agreement during ward rounds.
Research assistants directly observed medicine services to quantify the amount
of time spent discussing each patient’s care inside versus outside the patient’s
room. “Time-at-bedside” was defined as the proportion of time spent discussing a
patient’s care in his or her room. Patient experience and patient–clinician care
agreement both were measured immediately after ward rounds. Results demonstrated
that the majority of patient and physicians completely agreement on planned
tests (66.3%), planned procedures (79.7%), medication changes (50.6%), and
discharge location (66.9%), but had no agreement on the patient’s main concern
(74.4%) and discharge date (50.6%). Time-at-bedside was not correlated with care
agreement or patient experience (P > .05 for all
comparisons). This study demonstrates that spending more time at the bedside
during ward rounds, alone, is insufficient to improve patient experience.
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Affiliation(s)
- John T Ratelle
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
- John Ratelle, Division of Hospital Internal
Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
| | - Michelle Herberts
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Donna Miller
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ashok Kumbamu
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of
Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Donna Lawson
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Eric Polley
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Thomas J Beckman
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Manojlovich M, Harrod M, Hofer T, Lafferty M, McBratnie M, Krein SL. Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study. BMJ Qual Saf 2020; 30:747-754. [PMID: 33168635 PMCID: PMC8140397 DOI: 10.1136/bmjqs-2020-011441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND How quickly physicians respond to communications from bedside nurses is important for the delivery of safe inpatient care. Delays in physician responsiveness can impede care or contribute to patient harm. Understanding contributory factors to physician responsiveness can provide insights to promote timely physician response, possibly improving communication to ensure safe patient care. The purpose of this study was to describe the factors contributing to physician responsiveness to text or numeric pages, telephone calls and face-to-face messages delivered by nurses on adult general care units. METHODS Using a qualitative design, we collected data through observation, shadowing, interviews and focus groups of bedside registered nurses and physicians who worked in four hospitals in the Midwest USA. We analysed the data using inductive content analysis. RESULTS A total of 155 physicians and nurses participated. Eighty-six nurses and 32 physicians participated in focus groups or individual interviews; we shadowed 37 physicians and nurses across all sites. Two major inter-related themes emerged, message and non-message related factors. Message-related factors included the medium nurses used to convey messages, physician preference for notification via one communication medium over another and the clarity of the message, all of which could cause confusion and thus a delayed response. Non-message related factors included trust and interpersonal relationships, and different perspectives between nurses and physicians on the same clinical issue that affected perceptions of urgency, and contributed to delays in responsiveness. CONCLUSIONS Physician responsiveness to communications from bedside nurses depends on a complex combination of factors related to the message itself and non-message related factors. How quickly physicians respond is a multifactorial phenomenon, and strategies to promote a timely response within the context of a given situation must be directed to both groups.
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Affiliation(s)
| | - Molly Harrod
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Timothy Hofer
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Megan Lafferty
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Sarah L Krein
- Center for Clinical Management Research, Department of Veterans Affair, Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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16
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Giménez-Espert MDC, Castellano-Rioja E, Prado-Gascó VJ. Empathy, emotional intelligence, and communication in Nursing: The moderating effect of the organizational factors. Rev Lat Am Enfermagem 2020; 28:e3333. [PMID: 32813778 PMCID: PMC7426143 DOI: 10.1590/1518-8345.3286.3333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 04/13/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: to evaluate the relation and the moderating effect of the organizational factors on the attitudes towards communication, empathy, and emotional intelligence in the nurses. Method: a cross-sectional study was conducted with a convenience sample of 268 nurses from Valencia, Spain. The attitudes towards communication were evaluated by means of the specifically designed instrument, those towards empathy with the Jefferson’s Scale of Empathy for Nursing Students, and those towards emotional intelligence by means of the Trait Meta-Mood Scale, consisting of 24 items. The effect of the studied variables was assessed by means of ANOVA, multiple linear regression models were applied, and the moderating effect was analyzed using PROCESS. Results: there are statistically significant differences based on the type on contract (permanent); and statistically significant differences were found in the cognitive dimension of the attitudes towards communication. Regarding the regression models, the perspective taking dimension of empathy was the main predictive variable tn the dimensions of the attitudes towards communication. Finally, a moderating effect of the type of contract was evidenced in the effect of emotional reparation over the cognitive dimension of the attitudes towards communication. Conclusion: the organizational factors exert an influence on the attitudes towards communication, empathy, and emotional intelligence.
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Abstract
Teamwork is essential to providing high-quality patient care. Hospital settings pose important challenges to teamwork. Measurement is key to understanding baseline performance and assessing whether teamwork is improving. The authors recommend a multifaceted approach, using a combination of complementary interventions with an ultimate goal that improved teamwork translates into improved patient outcomes.
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Affiliation(s)
- Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street, 7th Floor, Chicago, IL 60611, USA.
| | - Krystal Hanrahan
- Nursing Development, Magnet Program Manager, Northwestern Memorial Hospital, 251 East Huron Street, 4th Floor, Chicago, IL 60611, USA
| | - Rachel M Cyrus
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street, 7th Floor, Chicago, IL 60611, USA. https://twitter.com/rachelcyrus4
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Kara A, Flanagan ME, Gruber R, Lane KA, Bo N, Kroenke K, Weiner M. A Time Motion Study Evaluating the Impact of Geographic Cohorting of Hospitalists. J Hosp Med 2020; 15:338-344. [PMID: 31891555 DOI: 10.12788/jhm.3339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 09/29/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Geographic cohorting (GCh) localizes hospitalists to a unit. Our objective was to compare the GCh and non-GCh workday. METHODS In an academic, Midwestern hospital we observed hospitalists in GCh and non-GCh teams. Time in patient rooms was considered direct care; other locations were considered 'indirect' care. Geotracking identified time spent in each location and was obtained for 17 hospitalists. It was supplemented by in-person observation of four GCh and four non-GCh hospitalists for a workday each. Multilevel modeling was used to analyze associations between direct and indirect care time and team and workday characteristics. RESULTS Geotracking yielded 10,522 direct care episodes. GCh was associated with longer durations of patient visits while increasing patient loads were associated with shorter visits. GCh, increasing patient loads, and increasing numbers of units visited were associated with increased indirect care time. In-person observations yielded 3,032 minutes of data. GCh hospitalists were observed spending 56% of the day in computer interactions vs non-GCh hospitalists (39%; P < .005). The percentage of time spent multitasking was 18% for GCh and 14% for non-GCh hospitalists (P > .05). Interruptions were pervasive, but the highest interruption rate of once every eight minutes in the afternoon was noted in the GCh group. CONCLUSION GCh may have the potential to increase patient-hospitalist interactions but these gains may be attenuated if patient loads and the structure of cohorting are suboptimal. The hospitalist workday is cognitively intense. The interruptions noted may increase the time taken for time-intensive tasks like electronic medical record interactions.
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Affiliation(s)
- Areeba Kara
- Indiana University Health Physicians, Indianapolis, Indiana
- Indiana University School of Medicine, Indianapolis, Indiana
- ASPIRE Scholar Division of General Internal Medicine and Geriatrics, Indianapolis, Indiana
| | - Mindy E Flanagan
- William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana
| | - Rachel Gruber
- William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana
| | - Kathleen A Lane
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Na Bo
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kurt Kroenke
- Indiana University School of Medicine, Indianapolis, Indiana
- William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana
| | - Michael Weiner
- Indiana University School of Medicine, Indianapolis, Indiana
- William M. Tierney Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana
- US Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center Indianapolis, Indiana
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Shinwa M, Bossert A, Chen I, Cushing A, Dunn AS, Poeran J, Weinstein S, Cho HJ. "THINK" Before You Order: Multidisciplinary Initiative to Reduce Unnecessary Lab Testing. J Healthc Qual 2020; 41:165-171. [PMID: 31094950 DOI: 10.1097/jhq.0000000000000157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inappropriate daily lab testing can have adverse effects on patients, including anemia, pain, and interruption of sleep. We implemented a student-led, multifaceted intervention featuring clinician education, publicity campaign, gamification, and system changes, including a novel nurse-driven protocol to reduce unnecessary daily lab testing in a teaching hospital. We applied a quasi-experimental interrupted time series design with a segmented regression analysis to estimate changes before and after our 14-month intervention with a comparison to a control surgical unit. There was an increasing trend in the baseline period, which was mitigated by the intervention (postintervention effect estimate -0.04 labs per patient day/month, p < .05), which was not seen in the control unit. Estimated cost savings was $94,269 ($6,734/month). A student-led, multidisciplinary campaign involving nurse-driven pathway, education, publicity, gamification, and system changes was effective in reducing daily lab testing.
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20
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Using Qualitative Methods to Explore Communication Practices in the Context of Patient Care Rounds on General Care Units. J Gen Intern Med 2020; 35:839-845. [PMID: 31832929 PMCID: PMC7080921 DOI: 10.1007/s11606-019-05580-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Poor communication between physicians and nurses is a significant contributor to adverse events for hospitalized patients. Overcoming communication difficulties requires examining communication practices to better understand some of the factors that affect the nurse-physician communication process. OBJECTIVE To develop a more detailed understanding of communication practices between nurses and physicians on general care units. We focused on patient care rounds as an important activity in the care delivery process for communication. DESIGN Qualitative study design PARTICIPANTS: A total of 163 physicians, registered nurses, and nurse practitioners who worked on pre-specified general care units in each of four hospitals in the Midwest. APPROACH On each unit, data collection consisted of 2 weeks of observing and shadowing clinicians during rounds and at other times, as well as asking clinicians questions about rounds and communication during interviews and focus groups. A directed content analysis approach was used to code and analyze the data. KEY RESULTS Workflow differences contributed to organizational complexity, affecting rounds and subsequently communication practices, both across and within provider types. Nurse and patient participation during rounds appeared to reduce interruptions and hence cognitive load for physicians and nurses. Physicians adopted certain behaviors within the social context to improve communication, such as socializing and building relationships with the nurses, which contributed to nurse participation in rounds. When rapport was lacking, some nurses felt uncomfortable joining physicians during rounds unless they were explicitly invited. CONCLUSIONS Improving communication requires bringing attention to three contextual dimensions of communication: organizational complexity, cognitive load, and the social context. Initiatives that seek to improve communication may be more successful if they acknowledge the complexity of communication and the context in which it occurs.
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Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. HUMAN RESOURCES FOR HEALTH 2020; 18:2. [PMID: 31915007 PMCID: PMC6950792 DOI: 10.1186/s12960-019-0411-3] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 09/05/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND A high variety of team interventions aims to improve team performance outcomes. In 2008, we conducted a systematic review to provide an overview of the scientific studies focused on these interventions. However, over the past decade, the literature on team interventions has rapidly evolved. An updated overview is therefore required, and it will focus on all possible team interventions without restrictions to a type of intervention, setting, or research design. OBJECTIVES To review the literature from the past decade on interventions with the goal of improving team effectiveness within healthcare organizations and identify the "evidence base" levels of the research. METHODS Seven major databases were systematically searched for relevant articles published between 2008 and July 2018. Of the original search yield of 6025 studies, 297 studies met the inclusion criteria according to three independent authors and were subsequently included for analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Scale was used to assess the level of empirical evidence. RESULTS Three types of interventions were distinguished: (1) Training, which is sub-divided into training that is based on predefined principles (i.e. CRM: crew resource management and TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety), on a specific method (i.e. simulation), or on general team training. (2) Tools covers tools that structure (i.e. SBAR: Situation, Background, Assessment, and Recommendation, (de)briefing checklists, and rounds), facilitate (through communication technology), or trigger (through monitoring and feedback) teamwork. (3) Organizational (re)design is about (re)designing structures to stimulate team processes and team functioning. (4) A programme is a combination of the previous types. The majority of studies evaluated a training focused on the (acute) hospital care setting. Most of the evaluated interventions focused on improving non-technical skills and provided evidence of improvements. CONCLUSION Over the last decade, the number of studies on team interventions has increased exponentially. At the same time, research tends to focus on certain interventions, settings, and/or outcomes. Principle-based training (i.e. CRM and TeamSTEPPS) and simulation-based training seem to provide the greatest opportunities for reaching the improvement goals in team functioning.
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Affiliation(s)
- Martina Buljac-Samardzic
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Kirti D. Doekhie
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
| | - Jeroen D. H. van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle building, p.o. box 1738, 3000 DR Rotterdam, The Netherlands
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Maniaci MJ, Dawson NL, Cowart JB, Richie EM, Suryaprasad AG, Hodge DO, Joyce NE, Kernan CA, Stone LA, Burton MC. Goal-Directed Achievement Through Geographic Location (GAGL) Reduces Patient Length of Stay and Adverse Events. Am J Med Qual 2019; 35:323-329. [PMID: 31581786 DOI: 10.1177/1062860619879977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This prospective cohort study aimed to improve hospital outcomes through geographic location of hospitalist patients and conducting daily multidisciplinary team rounds-Goal-directed Achievements through Geographic Location (GAGL). Patients were admitted to a geographic (GAGL) study unit where daily multidisciplinary rounds took place among nursing, case management, a hospitalist, pharmacy, physical and occupational therapy, respiratory therapy, and nutrition services. A total of 985 (56.4%) patients were admitted to the GAGL study unit and 760 patients (43.6%) were admitted to non-GAGL units. Patients admitted to the GAGL study unit had a shorter average length of stay (3.64 days vs 4.35 days, P = .0001) and a lower number of risk events (91 [9.2%] vs 93 [12.2%], P = .038). There was no significant difference in 30-day readmissions, avoidable day events, or code blue team activations. GAGL provides a framework for hospital organizations to improve provider communication, hospital efficiency, and patient safety.
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Torabizadeh C, Bahmani T, Molazem Z, Moayedi SA. Development and Psychometric Evaluation of a Professional Communication Questionnaire for the Operating Room. HEALTH COMMUNICATION 2019; 34:1313-1319. [PMID: 29902060 DOI: 10.1080/10410236.2018.1484268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Effective communications play a significant role in environments where health care is provided. A review of the available literature did not yield a valid scale for evaluation of operating room nurse-doctor communication. Accordingly, the present study is an attempt at development and psychometric evaluation of a professional communication questionnaire for the operating room. The present study is a methodological work conducted in two steps. In the first stage of the study, 56 items on a 5-point Likert scale were developed according to the results of a review of relevant literature and several meetings with experts. Next, following a qualitative and quantitative evaluation of the face and content validity of the questionnaire, 41 items remained. An assessment of the construct validity of the questionnaire using factor analysis yielded six factors. In this stage, 410 operating room nurses and doctors who were randomly selected from six hospitals affiliated with the university participated. Cronbach's alpha for the internal homogeneity of the instrument was found to be .88; the results of the test-retest showed its consistency to be .91. The findings show that the developed instrument has enough validity and reliability to be used to evaluate professional communication in operating rooms.
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Affiliation(s)
| | - Tayebeh Bahmani
- Student Research Committee, Shiraz University of Medical Sciences
| | - Zahra Molazem
- Department of Nursing, Shiraz University of Medical Sciences
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Harrod M, Petersen L, Weston LE, Gregory L, Mayer J, Samore MH, Drews FA, Krein SL. Understanding Workflow and Personal Protective Equipment Challenges Across Different Healthcare Personnel Roles. Clin Infect Dis 2019; 69:S185-S191. [DOI: 10.1093/cid/ciz527] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Hospitals use standard and transmission-based precautions, including personal protective equipment (PPE), to prevent the spread of infectious organisms. However, little attention has been paid to the potentially unique challenges of various healthcare personnel (HCP) in following precaution practices.
Methods
From September through December 2016, 5 physicians, 5 nurses, and 4 physical therapists were shadowed for 1 hour 30 minutes to 3 hours 15 minutes at an academic medical center. Observers documented activities using unstructured field notes. Focus groups were conducted to better understand HCP perspectives about precautions and PPE-related challenges. Data were analyzed by comparing workflow and challenges (observed and stated) in precaution practices across HCP roles.
Results
Precaution patients were interspersed throughout physician rounds, which covered a broad geographic range throughout the hospital. Patient encounters were generally brief, and appropriate use of gowns and cleaning of personal stethoscopes varied among observed physicians. Nurses were unit based and frequently entered/exited rooms. Frustration with donning/doffing was especially apparent when needing supplies while in a precaution room, which nurses acknowledged was a time when practice lapses could occur. The observed physical therapists worked in one geographic location, spent extended periods of time with patients, and noted that given their close physical contact with patients, gowns do not fully protect them.
Conclusions
Movement patterns, time with patients, care activities, and equipment use varied across HCP, leading to a diverse set of challenges in following precaution practices and PPE use. Attention to these differences among HCP is important for understanding and developing effective strategies to prevent the potential spread of infectious organisms.
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Affiliation(s)
- Molly Harrod
- Veterans Affairs Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Laura Petersen
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Lauren E Weston
- Veterans Affairs Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Lynn Gregory
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Jeanmarie Mayer
- Department of Internal Medicine, University of Utah, Salt Lake City
- Department of Veterans Affairs Medical Center, Salt Lake City
| | - Matthew H Samore
- Department of Veterans Affairs Medical Center, Salt Lake City
- Department of Psychology, University of Utah, Salt Lake City
| | - Frank A Drews
- Department of Internal Medicine, University of Utah, Salt Lake City
- Department of Veterans Affairs Medical Center, Salt Lake City
- Department of Psychology, University of Utah, Salt Lake City
| | - Sarah L Krein
- Veterans Affairs Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
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Dalal AK, Dykes P, Samal L, McNally K, Mlaver E, Yoon CS, Lipsitz SR, Bates DW. Potential of an Electronic Health Record-Integrated Patient Portal for Improving Care Plan Concordance during Acute Care. Appl Clin Inform 2019; 10:358-366. [PMID: 31141830 DOI: 10.1055/s-0039-1688831] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Care plan concordance among patients and clinicians during hospitalization is suboptimal. OBJECTIVE This article determines whether an electronic health record (EHR)-integrated patient portal was associated with increased understanding of the care plan, including the key recovery goal, among patients and clinicians in acute care setting. METHODS The intervention included (1) a patient portal configured to solicit a single patient-designated recovery goal and display the care plan from the EHR for participating patients; and (2) an electronic care plan for all unit-based nurses that displays patient-inputted information, accessible to all clinicians via the EHR. Patients admitted to an oncology unit, including their nurses and physicians, were enrolled before and after implementation. Main outcomes included mean concordance scores for the overall care plan and individual care plan elements. RESULTS Of 457 and 283 eligible patients approached during pre- and postintervention periods, 55 and 46 participated in interviews, respectively, including their clinicians. Of 46 postintervention patients, 27 (58.7%) enrolled in the patient portal. The intention-to-treat analysis demonstrated a nonsignificant increase in the mean concordance score for the overall care plan (62.0-67.1, adjusted p = 0.13), and significant increases in mean concordance scores for the recovery goal (30.3-57.7, adjusted p < 0.01) and main reason for hospitalization (58.6-79.2, adjusted p < 0.01). The on-treatment analysis of patient portal enrollees demonstrated significant increases in mean concordance scores for the overall care plan (61.9-70.0, adjusted p < 0.01), the recovery goal (30.4-66.8, adjusted p < 0.01), and main reason for hospitalization (58.3-81.7, adjusted p < 0.01), comparable to the intention-to-treat analysis. CONCLUSION Implementation of an EHR-integrated patient portal was associated with increased concordance for key care plan components. Future efforts should be directed at improving concordance for other care plan components and conducting larger, randomized studies to evaluate the impact on key outcomes during transitions of care. CLINICAL TRIALS IDENTIFIER NCT02258594.
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Affiliation(s)
- Anuj K Dalal
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Harvard University, Boston, Massachusetts, United States
| | - Patricia Dykes
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Harvard University, Boston, Massachusetts, United States
| | - Lipika Samal
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Harvard University, Boston, Massachusetts, United States
| | - Kelly McNally
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Eli Mlaver
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Cathy S Yoon
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Stuart R Lipsitz
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Harvard University, Boston, Massachusetts, United States
| | - David W Bates
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Harvard University, Boston, Massachusetts, United States
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O'Leary KJ, Johnson JK, Manojlovich M, Goldstein JD, Lee J, Williams MV. Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems. BMC Health Serv Res 2019; 19:293. [PMID: 31068161 PMCID: PMC6505207 DOI: 10.1186/s12913-019-4116-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/22/2019] [Indexed: 11/25/2022] Open
Abstract
Background A number of challenges impede our ability to consistently provide high quality care to patients hospitalized with medical conditions. Teams are large, team membership continually evolves, and physicians are often spread across multiple units and floors. Moreover, patients and family members are generally poorly informed and lack opportunities to partner in decision making. Prior studies have tested interventions to redesign aspects of the care delivery system for hospitalized medical patients, but the majority have evaluated the effect of a single intervention. We believe these interventions represent complementary and mutually reinforcing components of a redesigned clinical microsystem. Our specific objective for this study is to implement a set of evidence-based complementary interventions across a range of clinical microsystems, identify factors and strategies associated with successful implementation, and evaluate the impact on quality. Methods The RESET project uses the Advanced and Integrated MicroSystems (AIMS) interventions. The AIMS interventions consist of 1) Unit-based Physician Teams, 2) Unit Nurse-Physician Co-leadership, 3) Enhanced Interprofessional Rounds, 4) Unit-level Performance Reports, and 5) Patient Engagement Activities. Four hospital sites were chosen to receive guidance and resources as they implement the AIMS interventions. Each study site has assembled a local leadership team, consisting of a physician and nurse, and receives mentorship from a physician and nurse with experience in leading similar interventions. Primary outcomes include teamwork climate, assessed using the Safety Attitudes Questionnaire, and adverse events using the Medicare Patient Safety Monitoring System (MPSMS). RESET uses a parallel group study design and two group pretest-posttest analyses for primary outcomes. We use a multi-method approach to collect and triangulate qualitative data collected during 3 visits to study sites. We will use cross-case comparisons to consider how site-specific contextual factors interact with the variation in the intensity and fidelity of implementation to affect teamwork and patient outcomes. Discussion The RESET study provides mentorship and resources to assist hospitals as they implement complementary and mutually reinforcing components to redesign the clinical microsystems caring for medical patients. Our findings will be of interest and directly applicable to all hospitals providing care to patients with medical conditions. Trial registration NCT03745677. Retrospectively registered on November 19, 2018. Electronic supplementary material The online version of this article (10.1186/s12913-019-4116-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 211 E. Ontario Street, Suite 700, Chicago, IL, 60611, USA.
| | - Julie K Johnson
- Department of Surgery and the Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Milisa Manojlovich
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Jenna D Goldstein
- Center for Hospital Innovation and Improvement, Society of Hospital Medicine, Philadelphia, PA, USA
| | - Jungwha Lee
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mark V Williams
- Center for Health Services Research, University of Kentucky College of Medicine, Lexington, KY, USA
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Owen DC, Ashcraft AS. Creating Shared Meaning: Communication Between Nurses and Physicians in Nursing Homes. Res Gerontol Nurs 2019; 12:121-132. [PMID: 30901480 DOI: 10.3928/19404921-20190315-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 02/13/2019] [Indexed: 11/20/2022]
Abstract
The current study sought to obtain pilot data from a Situation, Background, Assessment, Recommendation (SBAR) communication intervention focused on the shared meaning construct of the sensemaking model and explore shared meaning in communication between nursing home (NH) nurses and physicians. The study design was an exploratory sequential mixed method with a pre/post quasi-experiment. Grounded theory was used to collect and analyze nurse and physician interviews and medical records. The Pathway to Shared Meaning model illustrating distinct processes supported use of the sensemaking model for understanding nurse-physician communication. Quantitative changes in communication were not significant. Shared meaning and training in SBAR for communication can be used to strengthen the design and use of structured communication in NHs. TARGETS Nurses and physicians providing direct care in NHs. INTERVENTION DESCRIPTION Stories describing nurse-physician sharing of resident information using SBAR. MECHANISM OF ACTION Mutual understanding of one another's perspective enhances communication. OUTCOME Communication openness and satisfaction. [Res Gerontol Nurs. 2019; 12(3):121-132.].
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Tang T, Heidebrecht C, Coburn A, Mansfield E, Roberto E, Lucez E, Lim ME, Reid R, Quan SD. Using an electronic tool to improve teamwork and interprofessional communication to meet the needs of complex hospitalized patients: A mixed methods study. Int J Med Inform 2019; 127:35-42. [PMID: 31128830 DOI: 10.1016/j.ijmedinf.2019.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/29/2019] [Accepted: 04/12/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Teamwork and interprofessional communication are important in addressing the comprehensive care needs of complex hospitalized patients. The objective of this study is to evaluate the impact of an electronic interprofessional communication and collaboration platform on teamwork, communication, and adverse events in the hospital setting. MATERIALS AND METHODS In this mixed methods study, we used a quasi-experimental design in the quantitative component and deployed the electronic tool in a staged fashion to 2 hospital wards 3 months apart. We measured teamwork, communication, and adverse events with Relational Coordination survey, video recordings of team rounds, and retrospective chart review. We conducted qualitative semi-structured interviews with clinicians to understand the perceived impacts of the electronic tool and other contextual factors. RESULTS Teamwork sustainably improved (overall Relational Coordination score improved from 3.68 at baseline to 3.84 at three and six months after intervention, p = 0.03) on ward 1. A small change in face-to-face communication pattern during team rounds was observed (making plans increased from 22% to 24%, p = 0.004) at 3 months on ward 1 but was not sustained at 6 months. Teamwork and communication did not change after the intervention on ward 2. There was no meaningful change to adverse event rates on either ward. Clinicians reported generally positive views about the electronic tool's impact but described non-technology factors on each ward that affected teamwork and communication. CONCLUSION The impact of using an electronic tool to improve teamwork and communication in the hospital setting appears mixed, but can be positive in some settings. Improving teamwork and communication likely require both appropriate technology and addressing non-technology factors.
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Affiliation(s)
- Terence Tang
- Institute for Better Health and Program of Medicine, Trillium Health Partners, 100 Queensway West, Clinical Administrative Building, 6th floor, Mississauga, Ontario, L5B 1B8, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | | | - Andrea Coburn
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Elizabeth Mansfield
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Canada
| | - Ellen Roberto
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Emanuel Lucez
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Morgan E Lim
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Robert Reid
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Sherman D Quan
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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Abstract
Nurses practicing at every level need a clear definition of collaboration before applying the concept in daily practice. Additionally, a conceptual definition of collaboration in nursing assists nurse researchers in finding or developing instruments for measuring collaboration and attributes of collaboration, which will enhance research findings. Collaboration extends beyond communication and includes sharing, teamwork, and respect. Multiple databases including CINAHL, PubMed, and ERIC were searched using the keywords collaboration, nursing, concept analysis, sharing, respect, and teamwork. For this analysis, using Walker and Avant's method, the conceptual definition of collaboration in nursing is an intraprofessional or interprofessional process by which nurses come together and form a team to solve a patient care or healthcare system problem with members of the team respectfully sharing knowledge and resources. Two instruments consistent with the conceptual definition of collaboration are The Mayo High Performance Teamwork Scale (MHPTS) and Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS) and these instruments are summarized in this study. Finally, case scenarios are given to illustrate exemplars of collaboration in clinical practice.
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Affiliation(s)
- Cheryl Emich
- The University of Alabama in Huntsville, College of Nursing, Huntsville, Alabama
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The influence of effective communication, perceived respect and willingness to collaborate on nurses' perceptions of nurse-physician collaboration in China. Appl Nurs Res 2018; 41:73-79. [PMID: 29853219 DOI: 10.1016/j.apnr.2018.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Nurse-physician collaboration is a critical prerequisite for high-quality care. Previous researchers have addressed multiple factors that influence collaboration. However, little of this research has explored the influence of interactional factors on nurses' perception of nurse-physician collaboration in China. AIMS To examine the influence of interactional factors (effective communication, perceived respect and willingness to collaborate) on nurses' perception of nurse-physician collaboration. METHODS A cross-sectional survey of 971 registered nurses in nine hospitals was conducted. An author-designed interactional factor questionnaire and the Nurse-Physician Collaboration Scale were used to collect data. Multiple regression analysis was used. RESULTS Nurse-physician collaboration was identified as at a moderate level (mean = 3.93 ± 0.68). Interactional factors (effective communication, perceived respect and willingness to collaborate) were identified as relatively moderate to high (mean = 4.03 ± 0.68, mean = 3.87 ± 0.75, mean = 4.50 ± 0.59, respectively). The results showed that effective communication, perceived respect and willingness to collaborate explained 57.3% of the variance in nurses' perception of nurse-physician collaboration (Adjusted R2 = 0.573, F = 435.563, P < 0.001). Perceived respect (β = 0.378) was the strongest factor relevant to nurses' perception of nurse-physician collaboration, second was effective communication (β = 0.315), and the weakest factor among these three factors was willingness to collaborate (β = 0.160). CONCLUSION Nurses' perceptions of collaboration were relatively positive, mainly in Sharing of patient information; however, improvements need to be made regarding Joint participation in the cure/care decision-making process. Effective communication, perceived respect and willingness to collaborate significantly affect nurses' perception of nurse-physician collaboration, with perceived respect having greater explanatory power among the three interactional factors. It is necessary for hospital managers to develop strategies to build professional respect for nurses, facilitate effective nurse-physician communication and improve nurses' willingness to collaborate.
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Li J, Talari P, Kelly A, Latham B, Dotson S, Manning K, Thornsberry L, Swartz C, Williams MV. Interprofessional Teamwork Innovation Model (ITIM) to promote communication and patient-centred, coordinated care. BMJ Qual Saf 2018; 27:700-709. [PMID: 29444853 DOI: 10.1136/bmjqs-2017-007369] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 01/02/2018] [Accepted: 01/19/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Despite recommendations and the need to accelerate redesign of delivery models to be team-based and patient-centred, professional silos and cultural and structural barriers that inhibit working together and communicating effectively still predominate in the hospital setting. Aiming to improve team-based rounding, we developed, implemented and evaluated the Interprofessional Teamwork Innovation Model (ITIM). METHODS This quality improvement (QI) study was conducted at an academic medical centre. We followed the system's QI framework, FOCUS-PDSA, with Lean as guiding principles. Primary outcomes included 30-day all-cause same-hospital readmissions and 30-day emergency department (ED) visits. The intervention group consisted of patients receiving care on two hospitalist ITIM teams, and patients receiving care from other hospitalist teams were matched with a control group. Outcomes were assessed using difference-in-difference analysis. RESULTS Team members reported enhanced communication and overall time savings. In multivariate modelling, patients discharged from hospitalist teams using the ITIM approach were associated with reduced 30-day same-hospital readmissions with an estimated point OR of 0.56 (95% CI 0.34 to 0.92), but there was no impact on 30-day same-hospital ED visits. Difference-in-difference analysis showed that ITIM was not associated with changes in average total direct costs nor average cost per patient day, after adjusting for all other covariates in the models, despite the addition of staff resources in the ITIM model. CONCLUSION The ITIM approach facilitates a collaborative environment in which patients and their family caregivers, physicians, nurses, pharmacists, case managers and others work and share in the process of care.
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Affiliation(s)
- Jing Li
- Department of Medicine, Center for Health Services Research, University of Kentucky, Lexington, Kentucky, USA
| | - Preetham Talari
- Division of Hospital Medicine, University of Kentucky HealthCare, Lexington, KY
| | - Andrew Kelly
- Department of Medicine, Center for Health Services Research, University of Kentucky, Lexington, Kentucky, USA
| | - Barbara Latham
- Office of Value and Innovation in Healthcare Delivery, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Sherri Dotson
- Nursing, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Kim Manning
- Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Lisa Thornsberry
- Nursing, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Colleen Swartz
- Nursing, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Mark V Williams
- Department of Medicine, Center for Health Services Research, University of Kentucky, Lexington, Kentucky, USA
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Giménez-Espert MDC, Prado-Gascó VJ. The moderator effect of sex on attitude toward communication, emotional intelligence, and empathy in the nursing field. Rev Lat Am Enfermagem 2017; 25:e2969. [PMID: 29236842 PMCID: PMC5738859 DOI: 10.1590/1518-8345.2018.2969] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/22/2017] [Indexed: 11/22/2022] Open
Abstract
Objectives: to analyze differences in the variables for the object of this study (attitude
toward communication, emotional intelligence, and empathy) according to sex;
verify correlations among variables between men and women and analyze regression
models according to sex. Method: the ATC was used to measure attitudes toward communication; the Jefferson Scale of
Empathy was used to measure empathy; and the Trait Meta Mood Scale 24 was used to
measure emotional intelligence. The sample was composed of 450 nurses working in 7
hospitals located in Valencia, Spain. The t-test for independent samples was used
to verify whether there were statistically significant differences, together with
a prior application of the Levene test to assess the equality of variances. The
correlations were analyzed using Person’s coefficient. Finally, the Beta
coefficients of variables predicting ATC’s dimensions were verified using
hierarchical multiple linear regression according to sex. Results: There are statistically significant differences based on sex for the variables,
correlations and power of prediction. Conclusions: This study presents evidence on how the levels of variables (attitudes toward
communication, EI, and empathy) vary among nurses according to sex, as well as the
relationships established among such variables.
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Affiliation(s)
- María Del Carmen Giménez-Espert
- Doctoral, Nursing, Doctoral, Facultad de Enfermería y Podología, Universidad de Valencia, Valencia, Spain., Nursing, Professor, Department of Nursing, Faculty of Health Sciences, European University of Valencia, Spain
| | - Vicente-Javier Prado-Gascó
- Doctoral, Social Psychology, Doctoral, Facultad de Psicología, Universidad de Valencia, Valencia, Spain., Social Psychology, Professor, Department of Social Psychology, Faculty of Health Sciences, University of Valencia, Spain
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Use of Unit-Based Interventions to Improve the Quality of Care for Hospitalized Medical Patients: A National Survey. Jt Comm J Qual Patient Saf 2017; 43:573-579. [DOI: 10.1016/j.jcjq.2017.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/29/2017] [Accepted: 05/22/2017] [Indexed: 11/19/2022]
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Prospective Evaluation of a Multifaceted Intervention to Improve Outcomes in Intensive Care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Crit Care Med 2017; 45:e806-e813. [PMID: 28471886 DOI: 10.1097/ccm.0000000000002449] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Studies comprehensively assessing interventions to improve team communication and to engage patients and care partners in ICUs are lacking. This study examines the effectiveness of a patient-centered care and engagement program in the medical ICU. DESIGN Prospective intervention study. SETTING Medical ICUs at large tertiary care center. PATIENTS Two thousand one hundred five patient admissions (1,030 before and 1,075 during the intervention) from July 2013 to May 2014 and July 2014 to May 2015. INTERVENTIONS Structured patient-centered care and engagement training program and web-based technology including ICU safety checklist, tools to develop shared care plan, and messaging platform. Patient and care partner access to online portal to view health information, participate in the care plan, and communicate with providers. MEASUREMENTS AND MAIN RESULTS Primary outcome was aggregate adverse event rate. Secondary outcomes included patient and care partner satisfaction, care plan concordance, and resource utilization. We included 2,105 patient admissions, (1,030 baseline and 1,075 during intervention periods). The aggregate rate of adverse events fell 29%, from 59.0 per 1,000 patient days (95% CI, 51.8-67.2) to 41.9 per 1,000 patient days (95% CI, 36.3-48.3; p < 0.001), during the intervention period. Satisfaction improved markedly from an overall hospital rating of 71.8 (95% CI, 61.1-82.6) to 93.3 (95% CI, 88.2-98.4; p < 0.001) for patients and from 84.3 (95% CI, 81.3-87.3) to 90.0 (95% CI, 88.1-91.9; p < 0.001) for care partners. No change in care plan concordance or resource utilization. CONCLUSIONS Implementation of a structured team communication and patient engagement program in the ICU was associated with a reduction in adverse events and improved patient and care partner satisfaction.
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Bryson C, Boynton G, Stepczynski A, Garb J, Kleppel R, Irani F, Natanasabapathy S, Stefan MS. Geographical assignment of hospitalists in an urban teaching hospital: feasibility and impact on efficiency and provider satisfaction. Hosp Pract (1995) 2017; 45:135-142. [PMID: 28707548 DOI: 10.1080/21548331.2017.1353884] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate whether implementation of a geographic model of assigning hospitalists is feasible and sustainable in a large hospitalist program and assess its impact on provider satisfaction, perceived efficiency and patient outcomes. METHODS Pre (3 months) - post (12 months) intervention study conducted from June 2014 through September 2015 at a tertiary care medical center with a large hospitalist program caring for patients scattered in 4 buildings and 16 floors. Hospitalists were assigned to a particular nursing unit (geographic assignment) with a goal of having over 80% of their assigned patients located on their assigned unit. Satisfaction and perceived efficiency were assessed through a survey administered before and after the intervention. RESULTS Geographic assignment percentage increased from an average of 60% in the pre-intervention period to 93% post-intervention. The number of hospitalists covering a 32 bed unit decreased from 8-10 pre to 2-3 post-intervention. A majority of physicians (87%) thought that geography had a positive impact on the overall quality of care. Respondents reported that they felt that geography increased time spent with patient/caregivers to discuss plan of care (p < 0.001); improved communication with nurses (p = 0.0009); and increased sense of teamwork with nurses/case managers (p < 0.001). Mean length of stay (4.54 vs 4.62 days), 30-day readmission rates (16.0% vs 16.6%) and patient satisfaction (79.9 vs 77.3) did not change significantly between the pre- and post-implementation period. The discharge before noon rate improved slightly (47.5% - 54.1%). CONCLUSIONS Implementation of a unit-based model in a large hospitalist program is feasible and sustainable with appropriate planning and support. The geographical model of care increased provider satisfaction and perceived efficiency; it also facilitated the implementation of other key interventions such as interdisciplinary rounds.
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Affiliation(s)
- Christine Bryson
- a Department of Medicine, Division of Hospital Medicine , Baystate Medical Center , Springfield , MA , USA.,b Department of Medicine , Tufts University School of Medicine , Boston , MA , USA
| | | | - Anna Stepczynski
- d Department of Medicine, Division of Geriatrics, General Medicine and Palliative Care , University of Arizona , Tucson , AZ , USA
| | - Jane Garb
- a Department of Medicine, Division of Hospital Medicine , Baystate Medical Center , Springfield , MA , USA
| | - Reva Kleppel
- a Department of Medicine, Division of Hospital Medicine , Baystate Medical Center , Springfield , MA , USA
| | - Farzan Irani
- a Department of Medicine, Division of Hospital Medicine , Baystate Medical Center , Springfield , MA , USA.,b Department of Medicine , Tufts University School of Medicine , Boston , MA , USA
| | - Siva Natanasabapathy
- a Department of Medicine, Division of Hospital Medicine , Baystate Medical Center , Springfield , MA , USA.,b Department of Medicine , Tufts University School of Medicine , Boston , MA , USA
| | - Mihaela S Stefan
- a Department of Medicine, Division of Hospital Medicine , Baystate Medical Center , Springfield , MA , USA.,b Department of Medicine , Tufts University School of Medicine , Boston , MA , USA
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Tan TC, Zhou H, Kelly M. Nurse-physician communication - An integrated review. J Clin Nurs 2017; 26:3974-3989. [DOI: 10.1111/jocn.13832] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | - Huaqiong Zhou
- School of Nursing, Midwifery and Paramedicine; Curtin University; Perth WA Australia
| | - Michelle Kelly
- School of Nursing, Midwifery and Paramedicine; Curtin University; Perth WA Australia
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Jain AK, Fennell ML, Chagpar AB, Connolly HK, Nembhard IM. Moving Toward Improved Teamwork in Cancer Care: The Role of Psychological Safety in Team Communication. J Oncol Pract 2016; 12:1000-1011. [DOI: 10.1200/jop.2016.013300] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Effective communication is a requirement in the teamwork necessary for improved coordination to deliver patient-centered, value-based cancer care. Communication is particularly important when care providers are geographically distributed or work across organizations. We review organizational and teams research on communication to highlight psychological safety as a key determinant of high-quality communication within teams. We first present the concept of psychological safety, findings about its communication effects for teamwork, and factors that affect it. We focus on five factors applicable to cancer care delivery: familiarity, clinical hierarchy–related status differences, geographic dispersion, boundary spanning, and leader behavior. To illustrate how these factors facilitate or hinder psychologically safe communication and teamwork in cancer care, we review the case of a patient as she experiences the treatment-planning process for early-stage breast cancer in a community setting. Our analysis is summarized in a key principle: Teamwork in cancer care requires high-quality communication, which depends on psychological safety for all team members, clinicians and patients alike. We conclude with a discussion of the implications of psychological safety in clinical care and suggestions for future research.
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Affiliation(s)
- Anshu K. Jain
- Ashland Bellefonte Cancer Center, Ashland, KY; Yale University, New Haven, CT; Brown University, Providence, RI; and HK Communications, San Francisco, CA
| | - Mary L. Fennell
- Ashland Bellefonte Cancer Center, Ashland, KY; Yale University, New Haven, CT; Brown University, Providence, RI; and HK Communications, San Francisco, CA
| | - Anees B. Chagpar
- Ashland Bellefonte Cancer Center, Ashland, KY; Yale University, New Haven, CT; Brown University, Providence, RI; and HK Communications, San Francisco, CA
| | - Hannah K. Connolly
- Ashland Bellefonte Cancer Center, Ashland, KY; Yale University, New Haven, CT; Brown University, Providence, RI; and HK Communications, San Francisco, CA
| | - Ingrid M. Nembhard
- Ashland Bellefonte Cancer Center, Ashland, KY; Yale University, New Haven, CT; Brown University, Providence, RI; and HK Communications, San Francisco, CA
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Gonzalo JD, Himes J, McGillen B, Shifflet V, Lehman E. Interprofessional collaborative care characteristics and the occurrence of bedside interprofessional rounds: a cross-sectional analysis. BMC Health Serv Res 2016; 16:459. [PMID: 27585973 PMCID: PMC5007992 DOI: 10.1186/s12913-016-1714-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 08/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interprofessional collaboration improves the quality of medical care, but integration into inpatient workflow has been limited. Identification of systems-based factors promoting or diminishing bedside interprofessional rounds (BIR), one method of interprofessional collaboration, is critical for potential improvements in collaboration in hospital settings. The objective of this study was to determine whether the percentage of bedside interprofessional rounds in 18 hospital-based clinical units is attributable to spatial, staffing, patient, or nursing perception characteristics. METHODS A prospective, cross-sectional assessment of data obtained from nursing audits in one large academic medical center on a sampling of hospitalized pediatric and adult patients in 18 units from November 2012 to October 2013 was performed. The primary outcome was the percentage of bedside interprofessional rounds, defined as encounters including one attending-level physician and a nurse discussing the case at the patient's bedside. Logistic regression models were constructed with four covariate domains: (1) spatial characteristics (unit type, bed number, square feet per bed), (2) staffing characteristics (nurse-to-patient ratios, admitting services to unit), (3) patient-level characteristics (length of stay, severity of illness), and (4) nursing perceptions of collegiality, staffing, and use of rounding scripts. RESULTS Of 29,173 patients assessed during 1241 audited unit-days, 21,493 patients received BIR (74 %, range 35-97 %). Factors independently associated with increased occurrence of bedside interprofessional rounds were: intensive care unit (odds ratio 9.63, [CI 5.30-17.42]), intermediate care unit (odds ratio 2.84, [CI 1.37-5.87]), hospital length of stay 5-7 days (odds ratio 1.89, [CI, 1.05-3.38]) and >7 days (odds ratio 2.27, [CI, 1.28-4.02]), use of rounding script (odds ratio 2.20, [CI 1.15-4.23]), and perceived provider/leadership support (odds ratio 3.25, [CI 1.83-5.77]). CONCLUSIONS Variation of bedside interprofessional rounds was more attributable to unit type and perceived support rather than spatial or relationship characteristics amongst providers. Strategies for transforming the value of hospital care may require a reconfiguration of care delivery toward more integrated practice units.
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Affiliation(s)
- Jed D Gonzalo
- Medicine and Public Health Sciences, Health Systems Education, Pennsylvania State University College of Medicine, Hershey, PA, USA. .,Division of General Internal Medicine, Penn State Hershey Medical Center - HO34, 500 University Drive, Hershey, PA, 17033, USA.
| | - Judy Himes
- Nursing Medical Services, Neuroscience, and Cancer Institute, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Brian McGillen
- Division of General Internal Medicine, Penn State Hershey Medical Center - HO34, 500 University Drive, Hershey, PA, 17033, USA
| | - Vicki Shifflet
- General Medicine Acute Care Unit, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Erik Lehman
- Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Figueroa JF, Schnipper JL, McNally K, Stade D, Lipsitz SR, Dalal AK. How often are hospitalized patients and providers on the same page with regard to the patient's primary recovery goal for hospitalization? J Hosp Med 2016; 11:615-9. [PMID: 26929079 DOI: 10.1002/jhm.2569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND To deliver high-quality, patient-centered care during hospitalization, healthcare providers must correctly identify the patient's primary recovery goal. OBJECTIVE To determine the degree of concordance between patients and key hospital providers. DESIGN A validated questionnaire administered to a random sample of hospitalized patients alongside their nurse and physician provider. Goals included: "be cured," "live longer," "improve/maintain health," "be comfortable," "accomplish a particular life goal," or "other." SETTING Major academic hospital in Boston, Massachusetts. PARTICIPANTS Adult patients admitted for more than 48 hours from November 2013 to May 2014 were eligible. When a patient was incapacitated, a legal proxy was interviewed. The nurse and physician provider were then interviewed within 24 hours. MEASUREMENTS Frequencies of responses for each recovery goal and the rate of concordance among the patient, nurse, and physician provider were measured. The frequency of responses across groups were compared using adjusted χ(2) analyses. Inter-rater agreement was measured using 2-way Kappa tests. RESULTS All 3 participants were interviewed in 109 of the 181 (60.2%) patients approached (or with proxy available). Significant differences in selected goals were observed across respondent groups (P < 0.001). Patients frequently chose "be cured" (46.8%). Nurses and physician providers frequently selected "improve or maintain health" (38.5% and 46.8%, respectively). All 3 participants selected the same goal in 22 cases (20.2%). Inter-rater agreement was poor to slight for all pairs (kappa 0.09 [-0.03-0.19], 0.19 [0.08-0.30], and 0.20 [0.08-0.32] for patient-physician, patient-nurse, and nurse-physician, respectively). CONCLUSIONS We observed poor to slight concordance among hospitalized patients and key medical team members with regard to the patient's primary recovery goal. Journal of Hospital Medicine 2016;11:615-619. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Jose F Figueroa
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Jeffrey L Schnipper
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kelly McNally
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Diana Stade
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stuart R Lipsitz
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anuj K Dalal
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Mueller SK, Schnipper JL, Giannelli K, Roy CL, Boxer R. Impact of regionalized care on concordance of plan and preventable adverse events on general medicine services. J Hosp Med 2016; 11:620-7. [PMID: 26917417 PMCID: PMC11110896 DOI: 10.1002/jhm.2566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/14/2016] [Accepted: 01/28/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Dispersion of inpatient care teams across different medical units impedes effective team communication, potentially leading to adverse events (AEs). OBJECTIVE To regionalize 3 inpatient general medical teams to nursing units and examine the association with communication and preventable AEs. DESIGN Pre-post cohort analysis. SETTING A 700-bed academic medical center. PATIENTS General medicine patients on any of the participating nursing units before and after implementation of regionalized care. INTERVENTION Regionalizing 3 general medical physician teams to 3 corresponding nursing units. MEASUREMENTS Concordance of patient care plan between nurse and intern, and adjusted odds of preventable AEs. RESULTS Of the 414 included nurse and intern paired surveys, there were no significant differences pre- versus postregionalization in total mean concordance scores (0.65 vs 0.67, P = 0.26), but there was significant improvement in agreement on expected discharge date (0.56 vs 0.68, P = 0.003), knowledge of the other provider's name (0.56 vs 0.86,P < 0.001), and daily care plan discussions (0.73 vs 0.88, P < 0.001). Of the 392 reviewed patient medical records, there was no significant difference in the adjusted odds of preventable AEs pre- versus postregionalization (adjusted odds ratio: 1.37, 95% confidence interval: 0.69, 2.69). CONCLUSIONS We found that regionalization of care teams improved recognition of care team members, discussion of daily care plan, and agreement on estimated discharge date, but did not significantly improve nurse and physician concordance of the care plan or reduce the odds of preventable AEs. Our findings suggest that regionalization alone may be insufficient to effectively promote communication and lead to patient safety improvements. Journal of Hospital Medicine 2016;11:620-627. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Stephanie K Mueller
- Brigham and Women's Hospital Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Jeffrey L Schnipper
- Brigham and Women's Hospital Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Kyla Giannelli
- Brigham and Women's Hospital Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christopher L Roy
- Brigham and Women's Hospital Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Robert Boxer
- Brigham and Women's Hospital Hospitalist Service and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Dalal AK, Schnipper JL. Care team identification in the electronic health record: A critical first step for patient-centered communication. J Hosp Med 2016; 11:381-5. [PMID: 26762584 DOI: 10.1002/jhm.2542] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/10/2015] [Accepted: 12/15/2015] [Indexed: 11/07/2022]
Abstract
Patient-centered communication is essential to coordinate care and safely progress patients from admission through discharge. Hospitals struggle with improving the complex and increasingly electronic conversation patterns among care team members, patients, and caregivers to achieve effective patient-centered communication across settings. Accurate and reliable identification of all care team members is a precursor to effective patient-centered communication and ideally should be facilitated by the electronic health record. However, the process of identifying care team members is challenging, and team lists in the electronic health record are typically neither accurate nor reliable. Based on the literature and on experience from 2 initiatives at our institution, we outline strategies to improve care team identification in the electronic health record and discuss potential implications for patient-centered communication. Journal of Hospital Medicine 2016;11:381-385. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Anuj K Dalal
- Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey L Schnipper
- Division of General Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Kara A, Johnson CS, Nicley A, Niemeier MR, Hui SL. Redesigning inpatient care: Testing the effectiveness of an accountable care team model. J Hosp Med 2015; 10:773-9. [PMID: 26286828 DOI: 10.1002/jhm.2432] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/27/2015] [Accepted: 06/27/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND US healthcare underperforms on quality and safety metrics. Inpatient care constitutes an immense opportunity to intervene to improve care. OBJECTIVE Describe a model of inpatient care and measure its impact. DESIGN A quantitative assessment of the implementation of a new model of care. The graded implementation of the model allowed us to follow outcomes and measure their association with the dose of the implementation. SETTING AND PATIENTS Inpatient medical and surgical units in a large academic health center. INTERVENTION Eight interventions rooted in improving interprofessional collaboration (IPC), enabling data-driven decisions, and providing leadership were implemented. MEASUREMENTS Outcome data from August 2012 to December 2013 were analyzed using generalized linear mixed models for associations with the implementation of the model. Length of stay (LOS) index, case-mix index-adjusted variable direct costs (CMI-adjusted VDC), 30-day readmission rates, overall patient satisfaction scores, and provider satisfaction with the model were measured. RESULTS The implementation of the model was associated with decreases in LOS index (P < 0.0001) and CMI-adjusted VDC (P = 0.0006). We did not detect improvements in readmission rates or patient satisfaction scores. Most providers (95.8%, n = 92) agreed that the model had improved the quality and safety of the care delivered. CONCLUSIONS Creating an environment and framework in which IPC is fostered, performance data are transparently available, and leadership is provided may improve value on both medical and surgical units. These interventions appear to be well accepted by front-line staff. Readmission rates and patient satisfaction remain challenging.
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Affiliation(s)
- Areeba Kara
- Indiana University Health Physicians, Inpatient Medicine, Indiana University School of Medicine, IU Center for Health Innovation and Implementation Science, Indianapolis, Indiana
| | - Cynthia S Johnson
- Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, Indiana
| | - Amy Nicley
- Inpatient Programs and Accountable Care Units, Indiana University Health, Indianapolis, Indiana
| | - Michael R Niemeier
- Retired Chief Medical Officer Indiana University Health Methodist Hospital, Indianapolis, Indiana
| | - Siu L Hui
- Regenstrief Institute and Professor Emeritus Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
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O'Leary KJ, Killarney A, Hansen LO, Jones S, Malladi M, Marks K, M Shah H. Effect of patient-centred bedside rounds on hospitalised patients' decision control, activation and satisfaction with care. BMJ Qual Saf 2015; 25:921-928. [PMID: 26628552 DOI: 10.1136/bmjqs-2015-004561] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/06/2015] [Accepted: 11/09/2015] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Though interprofessional bedside rounds have been promoted to enhance patient-centred care for hospitalised patients, few studies have been conducted in adult hospital settings and evidence of impact is lacking. OBJECTIVE To evaluate the effect of patient-centred bedside rounds (PCBRs) on measures of patient-centred care. DESIGN AND SETTING Cluster randomised controlled trial involving four similar non-teaching hospitalist service units in a large urban hospital. PARTICIPANTS Hospitalised general medical patients. INTERVENTION We assembled working groups on two intervention units, consisting of professionals and patient/family members, to determine the optimal timing, duration and format for PCBR. Nurses and hospitalists rounded together in PCBR using a communication tool to provide a framework for discussion and unit leaders joined PCBR to provide coaching during initial weeks of implementation. MAIN OUTCOMES Using patient interviews, we assessed preferred and experienced roles in medical decision-making using the Control Preferences Scale, activation using the Short Form of the Patient Activation Measure, and satisfaction. We also compared postdischarge patient satisfaction survey items related to teamwork, involvement in decisions and overall care. We assessed nurses', physicians' and advanced practice providers' (APP) perceptions of PCBR using a survey developed for this study. RESULTS Overall, 650 patients were approached for structured interview during hospitalisation: 284 were excluded because of disorientation, 54 were excluded because of non-English language, 72 declined to participate and 4 withdrew from the study after enrolment. Interview data were available for 236 (122 control and 114 intervention unit) patients, and postdischarge satisfaction survey data were available for 493 (274 control and 219 intervention unit) patients. We found no significant differences in patients' perceptions of shared decision-making, activation or satisfaction with care. Results were similar in analyses based on whether PCBR had been performed (ie, per protocol). We also found no difference in postdischarge patient satisfaction items. Results were similar in multivariate analyses controlling for patient characteristics and clustering of patients within study units. A majority of nurses (78.6%), but only about half of hospitalist physicians and APPs felt that PCBR improved communication with patients (47.4%). A minority of nurses (46.4%) and physicians and APPs (36.8%) agreed that PCBR had improved the efficiency of their workday. CONCLUSIONS PCBR had no impact on patients' perceptions of shared decision-making, activation or satisfaction with care. Additional research is needed to identify optimal approaches that can be reliably implemented in hospital settings to improve patient-centred care.
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Affiliation(s)
- Kevin J O'Leary
- Hospital Medicine, Northwestern University, Chicago, Illinois, USA
| | - Audrey Killarney
- Hospital Medicine, Northwestern University, Chicago, Illinois, USA
| | - Luke O Hansen
- Hospital Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sasha Jones
- Hospital Medicine, Northwestern University, Chicago, Illinois, USA
| | - Megan Malladi
- Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Kelly Marks
- Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Hiren M Shah
- Hospital Medicine, Northwestern University, Chicago, Illinois, USA
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Pannick S, Beveridge I, Wachter RM, Sevdalis N. Improving the quality and safety of care on the medical ward: A review and synthesis of the evidence base. Eur J Intern Med 2014; 25:874-87. [PMID: 25457434 DOI: 10.1016/j.ejim.2014.10.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/13/2014] [Accepted: 10/13/2014] [Indexed: 11/17/2022]
Abstract
Despite its place at the heart of inpatient medicine, the evidence base underpinning the effective delivery of medical ward care is highly fragmented. Clinicians familiar with the selection of evidence-supported treatments for specific diseases may be less aware of the evolving literature surrounding the organisation of care on the medical ward. This review is the first synthesis of that disparate literature. An iterative search identified relevant publications, using terms pertaining to medical ward environments, and objective and subjective patient outcomes. Articles (including reviews) were selected on the basis of their focus on medical wards, and their relevance to the quality and safety of ward-based care. Responses to medical ward failings are grouped into five common themes: staffing levels and team composition; interdisciplinary communication and collaboration; standardisation of care; early recognition and treatment of the deteriorating patient; and local safety climate. Interventions in these categories are likely to improve the quality and safety of care in medical wards, although the evidence supporting them is constrained by methodological limitations and inadequate investment in multicentre trials. Nonetheless, with infrequent opportunities to redefine their services, institutions are increasingly adopting multifaceted strategies that encompass groups of these themes. As the literature on the quality of inpatient care moves beyond its initial focus on the intensive care unit and operating theatre, physicians should be mindful of opportunities to incorporate evidence-based practice at a ward level.
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Affiliation(s)
- Samuel Pannick
- NIHR Patient Safety Translational Research Centre, Imperial College London, and West Middlesex University Hospital NHS Trust, UK.
| | | | - Robert M Wachter
- Division of Hospital Medicine, University of CA, San Francisco, USA.
| | - Nick Sevdalis
- NIHR Patient Safety Translational Research Centre, Imperial College London, UK.
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Kim CS, King E, Stein J, Robinson E, Salameh M, O'Leary KJ. Unit-based interprofessional leadership models in six US hospitals. J Hosp Med 2014; 9:545-50. [PMID: 24799385 DOI: 10.1002/jhm.2200] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/14/2014] [Accepted: 03/23/2014] [Indexed: 11/07/2022]
Abstract
The landscape of hospital-based care has shifted to place greater emphasis on improving quality and delivering value. In response, hospitals and healthcare organizations must reassess their strategies to improve care delivery in their facilities and beyond. Although these institutional goals may be defined at the executive level, implementation takes place at local sites of care. To lead these efforts, hospitals need to appoint effective leaders at the frontlines. Hospitalists are well poised to take on the role of the local clinical care improvement leader based on their experiences as direct frontline caregivers and their integral roles in hospital-wide quality and safety initiatives. A unit-based leadership model consisting of a medical director paired with a nurse manager has been implemented in several hospitals to function as an effector arm in response to the changing landscape of inpatient care. We provide an overview of this new model of leadership and describe the experiences of 6 hospitals that have implemented it.
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Affiliation(s)
- Christopher S Kim
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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A qualitative evaluation of geographical localization of hospitalists: how unintended consequences may impact quality. J Gen Intern Med 2014; 29:1009-16. [PMID: 24549518 PMCID: PMC4061372 DOI: 10.1007/s11606-014-2780-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/20/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Geographical localization of hospitalist teams to nursing units may have an impact on the quality of inpatient care. The perceptions of individuals who provide patient care in a localized model of care have not been adequately studied. OBJECTIVE To determine the impact of geographic localization of hospitalist teams by evaluating the perceptions of hospitalists (faculty and physician assistants) localized to a single nursing unit and the nurses who staffed that unit. DESIGN Focus group study. SUBJECTS Six hospitalist faculty and three hospitalist physician assistants who provided patient care while localized to a single nursing unit, as well as 29 nurses who staffed the nursing unit where localization occurred. MAIN MEASURES Themes that emerged from grounded theory analysis of focus group transcripts. KEY RESULTS Participants perceived an overall positive impact of localization on the quality of patient care they provide and their workflow. The positive impact was mediated through proximity to patients and between members of the healthcare team, as well as through increased communication, decreased wasted time and increased teamwork. The participants also identified increased interruptions, variability in patient flow, mismatches in specialization and perverse incentives as mediating factors leading to unintended consequences. A model emerged that can inform future deployment and evaluation of localization interventions. CONCLUSIONS Geographical localization of hospitalist teams is perceived to be desirable by both hospitalists and nurses. Others who attempt localization could use our conceptual model as a guide to maximize the benefit and minimize the unintended consequences of this intervention.
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Hattori S. Capsule commentary on Singh et al., A qualitative evaluation of geographical localization of hospitalists: how unintended consequences may impact quality. J Gen Intern Med 2014; 29:1056. [PMID: 24664442 PMCID: PMC4061358 DOI: 10.1007/s11606-014-2837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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O’Leary KJ, Creden AJ, Slade ME, Landler MP, Kulkarni N, Lee J, Vozenilek JA, Pfeifer P, Eller S, Wayne DB, Williams MV. Implementation of Unit-Based Interventions to Improve Teamwork and Patient Safety on a Medical Service. Am J Med Qual 2014; 30:409-16. [DOI: 10.1177/1062860614538093] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kevin J. O’Leary
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amanda J. Creden
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - Nita Kulkarni
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jungwha Lee
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | - Diane B. Wayne
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Simons Y, Caprio T, Furiasse N, Kriss M, Williams MV, O'Leary KJ. The impact of facecards on patients' knowledge, satisfaction, trust, and agreement with hospital physicians: a pilot study. J Hosp Med 2014; 9:137-41. [PMID: 24214797 DOI: 10.1002/jhm.2100] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/27/2013] [Accepted: 09/30/2013] [Indexed: 11/05/2022]
Abstract
BACKGROUND Simple interventions such as facecards can improve patients' knowledge of names and roles of hospital physicians, but the effect on other aspects of the patient-physician relationship is not clear. OBJECTIVE To pilot an intervention to improve familiarity with physicians and assess its potential to improve patients' satisfaction, trust, and agreement with physicians. DESIGN Cluster randomized controlled trial assessing the impact of physician facecards. Physician facecards included pictures of physicians and descriptions of their roles. We performed structured interviews of randomly selected patients to assess outcomes. SETTING One of 2 similar hospitalist units and 1 of 2 teaching-service units in a large teaching hospital were randomly selected to implement the intervention. MEASUREMENTS Satisfaction with physician communication and overall hospital care was assessed using the Hospital Consumer Assessment of Healthcare Providers and Systems. Trust and agreement were each assessed through instruments used in prior research. RESULTS Overall, 138 patients completed interviews, with no differences in age, sex, or race between those receiving facecards and those not. More patients who received facecards correctly identified ≥1 hospital physician (89.1% vs 51.1%; P < 0.01) and their role (67.4% vs 16.3%; P < 0.01) than patients who had not received facecards. Patients had high baseline levels of satisfaction, trust, and agreement with hospital physicians, and we found no significant differences with the use of facecards. CONCLUSIONS Physician facecards improved patients' knowledge of the names and roles of hospital physicians. Larger studies are needed to assess the impact on satisfaction, trust, and agreement with physicians.
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Affiliation(s)
- Yael Simons
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Fanucchi L, Unterbrink M, Logio LS. (Re)turning the pages of residency: the impact of localizing resident physicians to hospital units on paging frequency. J Hosp Med 2014; 9:120-2. [PMID: 24382808 DOI: 10.1002/jhm.2143] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 11/27/2013] [Accepted: 12/09/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Geographic localization of physicians to patient care units may improve communication, decrease interruptions, and reduce resident workload. This study examines whether interns on geographically localized patient care units receive fewer pages than those on teams that are not. METHODS The study is a retrospective analysis of the number of pages received by interns on 5 internal medicine teams: 2 in a geographically localized model (GLM), 2 in a partial localization model (PLM), and 1 in a standard model (SM) over 1 month at New York-Presbyterian Hospital/Weill Cornell. Multivariate linear regression techniques were used to analyze the relationship between the number of pages received per intern and the type of team. RESULTS The number of pages received per intern per hour, adjusted for team census and number of admissions, was 2.2 (95% confidence interval [CI]: 2.0-2.4) in the GLM, 2.8 (95% CI: 2.6-3.0) in the PLM, and 3.9 (95% CI: 3.6-4.2) in the SM; all differences were statistically significant (P < 0.001). CONCLUSION Geographic localization of resident teams to patient care units was associated with significantly fewer pages received by interns during the day. Such patient care models may improve resident workload in part by decreasing pages, and consequently has important implications for patient safety and medical education.
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Affiliation(s)
- Laura Fanucchi
- Department of Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
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