Impact of Localizing Physicians to Hospital Units on Nurse—Physician Communication and Agreement on the Plan of Care

O’Leary, Kevin J.; Wayne, Diane B.; Landler, Matthew P.; Kulkarni, Nita Shrikant; Haviley, Corinne; Hahn, Katherine; Jeon, Jiyeon; Englert, Katherine M.; Williams, Mark

doi:10.1007/s11606-009-1113-7

Cited by 71 publications

(83 citation statements)

References 19 publications

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“…6,7 As such, the Accreditation Council of Graduate Medical Education emphasizes the quality of those hours, with a focus on several aspects of the resident working environment as key to improved educational and patient safety outcomes. [8][9][10] Geographic localization of physicians to patient care units has been proposed as a means to improve communication and agreement on plans of care, 11,12 and also to reduce resident workload by decreasing inefficiencies attributable to traveling throughout the hospital. 13 O'Leary, et al (2009) found that when physicians were localized to 1 hospital unit, there was greater agreement between physicians and nurses on various aspects of care, such as planned tests and anticipated length of stay.…”

Section: Resultsmentioning

confidence: 99%

(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency

2013

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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. Journal of Hospital Medicine 2014;9:120–122. © 2013 Society of Hospital Medicine

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Section: Resultsmentioning

confidence: 99%

(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency

2013

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“…As a result of a prior intervention, physicians' patients were localized to specific units in an effort to improve communication practices among nurses and physicians. 20 Beginning in March 2010, all general medical units held SIDR each weekday morning. SIDR took place in the unit conference room, was expected to last approximately 30-40 minutes, and was co-led by the unit nurse manager and a medical director.…”

Section: Setting and Study Designmentioning

confidence: 99%

Assessment of teamwork during structured interdisciplinary rounds on medical units

O’Leary

Boudreau

Creden

et al. 2012

Journal of Hospital Medicine

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BACKGROUND:Interdisciplinary rounds (IDR) provide a means to assemble hospital team members and improve collaboration. Little is known about teamwork during IDR.OBJECTIVE:To evaluate and characterize teamwork during IDR.DESIGN:Cross‐sectional observational study.SETTING:Six medical units which had implemented structured interdisciplinary rounds (SIDR).MEASUREMENTS:We adapted the Observational Teamwork Assessment for Surgery (OTAS) tool, a behaviorally anchored rating scale shown to be reliable and valid in surgical settings. OTAS provides scores ranging from 0 to 6 (0 = problematic behavior; 6 = exemplary behavior) across 5 domains (communication, coordination, cooperation/backup behavior, leadership, and monitoring/situational awareness) and for prespecified subteams. Two researchers conducted direct observations using the adapted OTAS tool.RESULTS:We conducted 7–8 independent observations for each unit (total = 44) and 20 joint observations. Inter‐rater reliability was excellent at the unit level (Spearman's rho = 0.75), and good across domains (rho = 0.53–0.68) and subteams (rho = 0.53–0.76) with the exception of the physician subteam, for which it was poor (rho = 0.35). Though teamwork scores were generally high, we found differences across units, with a median (interquartile range [IQR]) 4.5 (3.9–4.9) for the lowest and 5.4 (5.3–5.5) for the highest performing unit (P < 0.01). Domain scores differed, with leadership receiving the lowest (median [IQR] = 5.0 [4.6–5.3]), and cooperation/backup behavior and monitoring/situational awareness receiving highest scores (median [IQR] = 5.4 [5.0–5.5] and 5.4 [5.0–5.7]). Differences across subteams were of borderline significance (P = 0.05).CONCLUSIONS:The adapted OTAS instrument demonstrated acceptable reliability for assessing teamwork during SIDR across units, domains, and most subteams. Variation in performance suggests a need to improve consistency of teamwork and emphasizes the importance of leadership. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

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“…69,70 O'Leary and colleagues found improved awareness of care plans by the entire team. 71 Caution should be taken to assure proper physician-to-patient ratios, avoid physician isolation, and coordinate physician shifts with bed assignments. 69 To address some of these issues, groups have used a hybrid model where a hospitalist is primarily located on one unit but can ''flex'' or ''overflow'' onto another unit.…”

Section: Geographic Roundingmentioning

confidence: 99%

Evolving practice of hospital medicine and its impact on hospital throughput and efficiencies

Chadaga

Maher

Maller³

et al. 2012

Journal of Hospital Medicine

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Hospitalists are uniquely positioned to implement strategies to improve patient flow and efficiency. Hospital leaders have stated they expect hospitalists to comanage surgical patients, participate in observation units, and screen medical admissions, in addition to providing inpatient care for medical patients. We review how the hospitalists' role in acute inpatient care, surgical comanagement, short stay units, chest pain units, and active bed management has improved throughput and patient flow. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

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Impact of Localizing Physicians to Hospital Units on Nurse—Physician Communication and Agreement on the Plan of Care

Abstract: Although nurses and physicians were able to identify one another and communicated more frequently after localizing physicians to specific patient care units, there was little impact on nurse-physician agreement on the plan of care.

Cited by 71 publications

References 19 publications

(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency

(Re)turning the pages of residency: The impact of localizing resident physicians to hospital units on paging frequency

Assessment of teamwork during structured interdisciplinary rounds on medical units

Evolving practice of hospital medicine and its impact on hospital throughput and efficiencies

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