Simulated co-location of patients admitted to an inpatient internal medicine teaching unit: potential impacts on efficiency and physician-nurse collaboration

A systematic review of evidence-based practices for clinical education and health care delivery in the clinical teaching unit

“…High quality 56,63 Medium quality 21,22,55,61,62,64,65 Low quality 54,[57][58][59][60]66,67 Geographic wards may improve team efficiency and interprofessional collaboration. 14,28,56,68 Moderate confidence There are moderate concerns regarding adequacy and relevance. However, all studies are medium or high quality and coherent.…”

“…High quality 14,28,56,68 "Drip" continuous models of admission reduce daily variability in team workload that, in turn, may improve patient outcomes such as length of stay. 69,70 Moderate confidence There are moderate concerns regarding adequacy.…”

“…Four highquality studies explored geographic wards, in which patients and interprofessional care providers are colocalized in a sin gle physical location, such as a hospital unit or floor, reporting that this may improve team efficiency and interprofessional collaboration (Table 3). 14,28,56,68 In a timeseries study, introduction of geographic wards as part of a multipronged CTU redesign contributed to reduced rounding time and greater nurse attendance on rounds. 14 Outside of formal rounds, geographic wards also facilitated informal communication events between care providers.…”

“…56 In a quasi experimental study, a simulation model was used to colocate newly admitted patients with their assigned teams, which resulted in each team interacting with half as many nursing staff, thus improving com munication and increasing time for direct patient care for both phys icians and nurses. 68 Although geographic wards were feasible with a low patient census, they were challenging to implement at a higher census without extending wait times in the emergency department. 28…”

Designing the ultimate general medicine model

“…9 4 Co-location of patients with similar ages, acuity or type of illness can lead to efficiencies, including more streamlined processes of care. 10 Above all, we believe that the best general medicine care in our hospitals is supported by a process of internal review that is frequent, data-driven and engages clinicians from all professions within the department and all levels of seniority. A department that is self-examining, agile and willing to learn from failure should outperform one that is stagnant.…”