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Erschienen in: Journal of General Internal Medicine 8/2010

01.08.2010 | Original Research

Improving Teamwork: Impact of Structured Interdisciplinary Rounds on a Medical Teaching Unit

verfasst von: Kevin J. O’Leary, MD, MS, Diane B. Wayne, MD, Corinne Haviley, RN, MS, Maureen E. Slade, MS, RN, CS, Jungwha Lee, PhD, MPH, Mark V. Williams, MD

Erschienen in: Journal of General Internal Medicine | Ausgabe 8/2010

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Abstract

BACKGROUND

Effective collaboration and teamwork is essential in providing safe and effective hospital care. Prior research reveals deficiencies in collaboration on medical teaching units.

OBJECTIVE

The aim of this study was to assess the impact of an intervention, structured inter-disciplinary rounds (SIDR), on hospital care providers’ ratings of collaboration and teamwork.

METHODS

The study was a controlled trial comparing an intervention medical teaching unit with a similar control unit. The intervention, SIDR, combined a structured format for communication with a forum for regular interdisciplinary meetings. We surveyed providers on each unit and asked them to rate the quality of communication and collaboration they had experienced with other disciplines using a five-point ordinal scale. We also assessed the teamwork and safety climate using a validated instrument. Multivariable regression analyses were used to assess the impact on length of stay (LOS) and cost.

RESULTS

One hundred forty-seven of 159 (92%) eligible providers completed the survey. Although resident physicians on each unit rated the quality of communication and collaboration with nurses similarly, a greater percentage of nurses gave high ratings to the quality of collaboration with resident physicians on the intervention unit as compared to the control unit (74% vs. 44%; p = 0.02). Providers on the intervention unit rated the teamwork climate significantly higher as compared to the control unit (82.4 ± 11.7 vs. 77.3 ± 12.3; p = 0.01). The difference was explained by higher teamwork climate ratings on the part of nurses on the intervention unit (83.5 ± 14.7 vs. 74.2 ± 14.1; p = 0.005). Ratings of the safety climate were not significantly different between units. Adjusted LOS and hospital costs were not significantly different between units.

CONCLUSIONS

SIDR had a positive effect on nurses’ ratings of collaboration and teamwork on a medical teaching unit. Further study is required to assess the impact of SIDR on patient safety measures.
Literatur
2.
Zurück zum Zitat Donchin Y, Gopher D, Olin M, et al. A look into the nature and causes of human errors in the intensive care unit. Crit Care Med. 1995;23(2):294–300.CrossRefPubMed Donchin Y, Gopher D, Olin M, et al. A look into the nature and causes of human errors in the intensive care unit. Crit Care Med. 1995;23(2):294–300.CrossRefPubMed
3.
Zurück zum Zitat Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324(6):377–84.PubMedCrossRef Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324(6):377–84.PubMedCrossRef
4.
Zurück zum Zitat Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med. 2004;79(2):186–94.CrossRefPubMed Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med. 2004;79(2):186–94.CrossRefPubMed
5.
Zurück zum Zitat Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The Quality in Australian Health Care Study. Med J Aust. 1995;163(9):458–71.PubMed Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD. The Quality in Australian Health Care Study. Med J Aust. 1995;163(9):458–71.PubMed
6.
Zurück zum Zitat Makary MA, Sexton JB, Freischlag JA, et al. Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg. 2006;202(5):746–52.CrossRefPubMed Makary MA, Sexton JB, Freischlag JA, et al. Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg. 2006;202(5):746–52.CrossRefPubMed
7.
Zurück zum Zitat Thomas EJ, Sexton JB, Helmreich RL. Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med. 2003;31(3):956–9.CrossRefPubMed Thomas EJ, Sexton JB, Helmreich RL. Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med. 2003;31(3):956–9.CrossRefPubMed
8.
Zurück zum Zitat O'Leary KJ, Ritter CD, Wheeler H, Szekendi MK, Brinton TS, Williams MV. Teamwork on inpatient medical units: assessing attitudes and barriers. Qual Saf Health Care. 2010:19(2):117–21. O'Leary KJ, Ritter CD, Wheeler H, Szekendi MK, Brinton TS, Williams MV. Teamwork on inpatient medical units: assessing attitudes and barriers. Qual Saf Health Care. 2010:19(2):117–21.
9.
Zurück zum Zitat Evanoff B, Potter P, Wolf L, Grayson D, Dunagan C, Boxerman S. Can we talk? Priorities for patient care differed among health care providers: AHRQ; 2005. Evanoff B, Potter P, Wolf L, Grayson D, Dunagan C, Boxerman S. Can we talk? Priorities for patient care differed among health care providers: AHRQ; 2005.
10.
Zurück zum Zitat O'Leary KJ, Thompson JA, Landler MP, et al. Patterns of nurse—physicians communication and agreement on the plan of care. Qual Saf Health Care. In press. O'Leary KJ, Thompson JA, Landler MP, et al. Patterns of nurse—physicians communication and agreement on the plan of care. Qual Saf Health Care. In press.
11.
Zurück zum Zitat O'Mahony S, Mazur E, Charney P, Wang Y, Fine J. Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of stay. J Gen Intern Med. 2007;22(8):1073–9.CrossRefPubMed O'Mahony S, Mazur E, Charney P, Wang Y, Fine J. Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of stay. J Gen Intern Med. 2007;22(8):1073–9.CrossRefPubMed
12.
Zurück zum Zitat Vazirani S, Hays RD, Shapiro MF, Cowan M. Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. Am J Crit Care. 2005;14(1):71–7.PubMed Vazirani S, Hays RD, Shapiro MF, Cowan M. Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. Am J Crit Care. 2005;14(1):71–7.PubMed
13.
Zurück zum Zitat Curley C, McEachern JE, Speroff T. A firm trial of interdisciplinary rounds on the inpatient medical wards: an intervention designed using continuous quality improvement. Med Care. 1998;36(8 Suppl):AS4–12.CrossRefPubMed Curley C, McEachern JE, Speroff T. A firm trial of interdisciplinary rounds on the inpatient medical wards: an intervention designed using continuous quality improvement. Med Care. 1998;36(8 Suppl):AS4–12.CrossRefPubMed
14.
Zurück zum Zitat Wild D, Nawaz H, Chan W, Katz DL. Effects of interdisciplinary rounds on length of stay in a telemetry unit. J Public Health Manag Pract. 2004;10(1):63–9.PubMed Wild D, Nawaz H, Chan W, Katz DL. Effects of interdisciplinary rounds on length of stay in a telemetry unit. J Public Health Manag Pract. 2004;10(1):63–9.PubMed
15.
Zurück zum Zitat O'Leary KJ, Wayne DB, Landler MP, et al. Impact of Localizing Physicians to Hospital Units on Nurse-Physician Communication and Agreement on the Plan of Care. J Gen Intern Med. Sep 19 2009. O'Leary KJ, Wayne DB, Landler MP, et al. Impact of Localizing Physicians to Hospital Units on Nurse-Physician Communication and Agreement on the Plan of Care. J Gen Intern Med. Sep 19 2009.
16.
Zurück zum Zitat Narasimhan M, Eisen LA, Mahoney CD, Acerra FL, Rosen MJ. Improving nurse-physician communication and satisfaction in the intensive care unit with a daily goals worksheet. Am J Crit Care. 2006;15(2):217–22.PubMed Narasimhan M, Eisen LA, Mahoney CD, Acerra FL, Rosen MJ. Improving nurse-physician communication and satisfaction in the intensive care unit with a daily goals worksheet. Am J Crit Care. 2006;15(2):217–22.PubMed
17.
Zurück zum Zitat Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. Improving communication in the ICU using daily goals. J Crit Care. 2003;18(2):71–5.CrossRefPubMed Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. Improving communication in the ICU using daily goals. J Crit Care. 2003;18(2):71–5.CrossRefPubMed
18.
Zurück zum Zitat Sexton JB, Helmreich RL, Neilands TB, et al. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res. 2006;6:44.CrossRefPubMed Sexton JB, Helmreich RL, Neilands TB, et al. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res. 2006;6:44.CrossRefPubMed
19.
Zurück zum Zitat Helmreich RL, Merrit AC, Sherman PJ, Gregorich SE, Wiener EL. The Flight Management Attitudes Questionairre (FMAQ). Austin, TX: NASA/UT/FAA Technical Report 93-4; 1993. Helmreich RL, Merrit AC, Sherman PJ, Gregorich SE, Wiener EL. The Flight Management Attitudes Questionairre (FMAQ). Austin, TX: NASA/UT/FAA Technical Report 93-4; 1993.
20.
Zurück zum Zitat Sexton JB, Marsrch S, Helmreich RL, Betzendoerfer D, Kocher T, Scheidegger D. Jumpseating in the operating room. J Hum Perform Extreme Environ. 1996;1:2–36. Sexton JB, Marsrch S, Helmreich RL, Betzendoerfer D, Kocher T, Scheidegger D. Jumpseating in the operating room. J Hum Perform Extreme Environ. 1996;1:2–36.
21.
Zurück zum Zitat Thomas EJ, Sexton JB, Helmreich RL. Translating teamwork behaviours from aviation to healthcare: development of behavioural markers for neonatal resuscitation. Qual Saf Health Care. 2004;13(Suppl 1):i57–64.CrossRefPubMed Thomas EJ, Sexton JB, Helmreich RL. Translating teamwork behaviours from aviation to healthcare: development of behavioural markers for neonatal resuscitation. Qual Saf Health Care. 2004;13(Suppl 1):i57–64.CrossRefPubMed
22.
Zurück zum Zitat Kho ME, Carbone JM, Lucas J, Cook DJ. Safety Climate Survey: reliability of results from a multicenter ICU survey. Qual Saf Health Care. 2005;14(4):273–8.CrossRefPubMed Kho ME, Carbone JM, Lucas J, Cook DJ. Safety Climate Survey: reliability of results from a multicenter ICU survey. Qual Saf Health Care. 2005;14(4):273–8.CrossRefPubMed
23.
Zurück zum Zitat Sexton JB, Makary MA, Tersigni AR, et al. Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel. Anesthesiology. 2006;105(5):877–84.CrossRefPubMed Sexton JB, Makary MA, Tersigni AR, et al. Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel. Anesthesiology. 2006;105(5):877–84.CrossRefPubMed
24.
Zurück zum Zitat Davenport DL, Henderson WG, Mosca CL, Khuri SF, Mentzer RM Jr. Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions. J Am Coll Surg. 2007;205(6):778–84.CrossRefPubMed Davenport DL, Henderson WG, Mosca CL, Khuri SF, Mentzer RM Jr. Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions. J Am Coll Surg. 2007;205(6):778–84.CrossRefPubMed
26.
Zurück zum Zitat Auerbach AD, Wachter RM, Katz P, Showstack J, Baron RB, Goldman L. Implementation of a voluntary hospitalist service at a community teaching hospital: improved clinical efficiency and patient outcomes. Ann Intern Med. 2002;137(11):859–65.PubMed Auerbach AD, Wachter RM, Katz P, Showstack J, Baron RB, Goldman L. Implementation of a voluntary hospitalist service at a community teaching hospital: improved clinical efficiency and patient outcomes. Ann Intern Med. 2002;137(11):859–65.PubMed
27.
Zurück zum Zitat Meltzer D, Manning WG, Morrison J, et al. Effects of physician experience on costs and outcomes on an academic general medicine service: results of a trial of hospitalists. Ann Intern Med. 2002;137(11):866–74.PubMed Meltzer D, Manning WG, Morrison J, et al. Effects of physician experience on costs and outcomes on an academic general medicine service: results of a trial of hospitalists. Ann Intern Med. 2002;137(11):866–74.PubMed
28.
Zurück zum Zitat Southern WN, Berger MA, Bellin EY, Hailpern SM, Arnsten JH. Hospitalist care and length of stay in patients requiring complex discharge planning and close clinical monitoring. Arch Intern Med. 2007;167(17):1869–74.CrossRefPubMed Southern WN, Berger MA, Bellin EY, Hailpern SM, Arnsten JH. Hospitalist care and length of stay in patients requiring complex discharge planning and close clinical monitoring. Arch Intern Med. 2007;167(17):1869–74.CrossRefPubMed
29.
Zurück zum Zitat Weinberg DB, Miner DC, Rivlin L. 'It depends': medical residents' perspectives on working with nurses. Am J Nurs. 2009;109(7):34–43. quiz 44.PubMed Weinberg DB, Miner DC, Rivlin L. 'It depends': medical residents' perspectives on working with nurses. Am J Nurs. 2009;109(7):34–43. quiz 44.PubMed
30.
Zurück zum Zitat Mohr DC, Burgess JF Jr, Young GJ. The influence of teamwork culture on physician and nurse resignation rates in hospitals. Health Serv Manage Res. 2008;21(1):23–31.CrossRefPubMed Mohr DC, Burgess JF Jr, Young GJ. The influence of teamwork culture on physician and nurse resignation rates in hospitals. Health Serv Manage Res. 2008;21(1):23–31.CrossRefPubMed
31.
Zurück zum Zitat Rosenstein AH. Original research: nurse-physician relationships: impact on nurse satisfaction and retention. Am J Nurs. 2002;102(6):26–34.PubMed Rosenstein AH. Original research: nurse-physician relationships: impact on nurse satisfaction and retention. Am J Nurs. 2002;102(6):26–34.PubMed
32.
Zurück zum Zitat Baggs JG, Schmitt MH, Mushlin AI, et al. Association between nurse-physician collaboration and patient outcomes in three intensive care units. Crit Care Med. 1999;27(9):1991–8.CrossRefPubMed Baggs JG, Schmitt MH, Mushlin AI, et al. Association between nurse-physician collaboration and patient outcomes in three intensive care units. Crit Care Med. 1999;27(9):1991–8.CrossRefPubMed
33.
Zurück zum Zitat Wheelan SA, Burchill CN, Tilin F. The link between teamwork and patients' outcomes in intensive care units. Am J Crit Care. 2003;12(6):527–34.PubMed Wheelan SA, Burchill CN, Tilin F. The link between teamwork and patients' outcomes in intensive care units. Am J Crit Care. 2003;12(6):527–34.PubMed
34.
Zurück zum Zitat Cowan MJ, Shapiro M, Hays RD, et al. The effect of a multidisciplinary hospitalist/physician and advanced practice nurse collaboration on hospital costs. J Nurs Adm. 2006;36(2):79–85.CrossRefPubMed Cowan MJ, Shapiro M, Hays RD, et al. The effect of a multidisciplinary hospitalist/physician and advanced practice nurse collaboration on hospital costs. J Nurs Adm. 2006;36(2):79–85.CrossRefPubMed
Metadaten
Titel
Improving Teamwork: Impact of Structured Interdisciplinary Rounds on a Medical Teaching Unit
verfasst von
Kevin J. O’Leary, MD, MS
Diane B. Wayne, MD
Corinne Haviley, RN, MS
Maureen E. Slade, MS, RN, CS
Jungwha Lee, PhD, MPH
Mark V. Williams, MD
Publikationsdatum
01.08.2010
Verlag
Springer-Verlag
Erschienen in
Journal of General Internal Medicine / Ausgabe 8/2010
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-010-1345-6

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