Unit-Based Care Teams and the Frequency and Quality of Physician-Nurse Communications

Gordon, Mary Beth; Melvin, Patrice; Graham, Dionne; Fifer, E. Kim; Chiang, Vincent W.; Sectish, Theodore C.; Landrigan, Christopher P.

doi:10.1001/archpediatrics.2011.54

Cited by 23 publications

(16 citation statements)

References 25 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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“…Effective interprofessional collaboration requires common shared perceptions and expectations of each team member’s role [11], [15], [19]: Collaboration between residents and nurses contributes to the quality of teamwork, a necessary condition for optimal patient care [2], [3], [4], [5], [6], [24]. Overall, the perceptions of residents and nurses in our study were similar to many items of the Jefferson Scale of Attitude toward Physician–Nurse Collaboration which are deemed important by a group of nursing students [25].…”

Section: Discussionmentioning

confidence: 99%

“…In a randomized, controlled study, Curley [3] showed that interdisciplinary rounds in Internal Medicine decreased patients’ length of hospital stay and costs. Other studies showed that the same positive patient outcomes are associated with enhanced nurse-physician relationships [2], [4], [5], [6].…”

Section: Introductionmentioning

confidence: 99%

Interprofessional Collaboration on an Internal Medicine Ward: Role Perceptions and Expectations among Nurses and Residents

et al. 2013

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BackgroundEffective interprofessional collaboration requires that team members share common perceptions and expectations of each other's roles.ObjectiveDescribe and compare residents’ and nurses’ perceptions and expectations of their own and each other’s professional roles in the context of an Internal Medicine ward.MethodsA convenience sample of 14 residents and 14 nurses volunteers from the General Internal Medicine Division at the University Hospitals of Geneva, Switzerland, were interviewed to explore their perceptions and expectations of residents’ and nurses’ professional roles, for their own and the other profession. Interviews were analysed using thematic content analysis. The same respondents also filled a questionnaire asking their own intended actions and the expected actions from the other professional in response to 11 clinical scenarios.ResultsThree main themes emerged from the interviews: patient management, clinical reasoning and decision-making processes, and roles in the team. Nurses and residents shared general perceptions about patient management. However, there was a lack of shared perceptions and expectations regarding nurses’ autonomy in patient management, nurses’ participation in the decision-making process, professional interdependence, and residents’ implication in teamwork. Results from the clinical scenarios showed that nurses’ intended actions differed from residents’ expectations mainly regarding autonomy in patient management. Correlation between residents’ expectations and nurses’ intended actions was 0.56 (p = 0.08), while correlation between nurses’ expectations and residents’ intended actions was 0.80 (p<0.001).ConclusionsThere are discordant perceptions and unmet expectations among nurses and residents about each other’s roles, including several aspects related to the decision-making process. Interprofessional education should foster a shared vision of each other’s roles and clarify the boundaries of autonomy of each profession.

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“…Five general characteristics of team effectiveness emerged from this study: understanding and respecting team members’ roles; recognizing that creating and maintaining teamwork is an ongoing process; sharing a common understanding of primary health care; having the practical “know-how” for sharing patient care; and communication [12]. Communication was identified as the essential factor in effective teams [9], [12], [13]: “Improving communication would increase understanding, co-operation, and collaboration among team members” [12]. In another focus-group study [14], clear goals and attention to teamwork were identified as factors needed for team effectiveness in primary care.…”

Section: Introductionmentioning

confidence: 93%

“…The hospital is a context of complex clinical practice, heavy workload, and numerous team shifts. The quality of interprofessional and multidisciplinary collaboration is crucial and has been shown to influence patients’ readmission to intensive care unit [6], patients’ length of stay [7], and other outcomes [8], [9], [10], [11]. Effective teamwork requires specific cognitive, technical, and affective competence, as determined in a focus-group study conducted in the field of primary care [12].…”

Section: Introductionmentioning

confidence: 99%

Interprofessional Collaboration between Residents and Nurses in General Internal Medicine: A Qualitative Study on Behaviours Enhancing Teamwork Quality

et al. 2014

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BackgroundEffective teamwork is necessary for optimal patient care. There is insufficient understanding of interactions between physicians and nurses on internal medicine wards.ObjectiveTo describe resident physicians’ and nurses’ actual behaviours contributing to teamwork quality in the setting of a simulated internal medicine ward.MethodsA volunteer sample of 14 pairs of residents and nurses in internal medicine was asked to manage one non-urgent and one urgent clinical case in a simulated ward, using a high-fidelity manikin. After the simulation, participants attended a stimulated-recall session during which they viewed the videotape of the simulation and explained their actions and perceptions. All simulations were transcribed, coded, and analyzed, using a qualitative method (template analysis). Quality of teamwork was assessed, based on patient management efficiency and presence of shared management goals and of team spirit.ResultsMost resident-nurse pairs tended to interact in a traditional way, with residents taking the leadership and nurses executing medical prescriptions and assuming their own specific role. They also demonstrated different types of interactions involving shared responsibilities and decision making, constructive suggestions, active communication and listening, and manifestations of positive team building. The presence of a leader in the pair or a truly shared leadership between resident and nurse contributed to teamwork quality only if both members of the pair demonstrated sufficient autonomy. In case of a lack of autonomy of one member, the other member could compensate for it, if his/her own autonomy was sufficiently strong and if there were demonstrations of mutual listening, information sharing, and positive team building.ConclusionsAlthough they often relied on traditional types of interaction, residents and nurses also demonstrated readiness for increased sharing of responsibilities. Interprofessional education should insist on better redefinition of respective roles and reinforce behaviours shown to enhance teamwork quality.

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Unit-Based Care Teams and the Frequency and Quality of Physician-Nurse Communications

Cited by 23 publications

References 25 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

Interprofessional Collaboration on an Internal Medicine Ward: Role Perceptions and Expectations among Nurses and Residents

Interprofessional Collaboration between Residents and Nurses in General Internal Medicine: A Qualitative Study on Behaviours Enhancing Teamwork Quality

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