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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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Al Sabei SD, Ross AM. The Relationship between Nursing Leadership and Patient Readmission Rate: A Systematic Review. Can J Nurs Res 2023; 55:267-278. [PMID: 36734052 DOI: 10.1177/08445621231152959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Nurse leaders play a fundamental role in improving patient quality care delivery, thus improving patient clinical outcomes. PURPOSE This systematic review examined the knowledge to date of nursing leadership on reducing patient readmission rates. METHODS A literature review was conducted using seven electronic databases: Medline Ovid, PubMed, Cumulative Index to Nursing and Allied Health (CINAHL) Plus, Emerald, PsycINFO, ABI/INFORM collection, and EBSCO, with the addition of references for relevant papers reviewed. FINDINGS The search resulted in a total of 15 articles. Findings revealed that leadership practices of nurses have an impact on reducing patient readmission rates. CONCLUSIONS The results suggest a need for further rigorous studies investigating the mechanism of how nursing leadership relates to patient readmission rates and how to translate this into practice across diverse cultures.
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Affiliation(s)
- Sulaiman Dawood Al Sabei
- Fundamentals and Nursing Administration Department, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Amy M Ross
- Systems & Organizational Leadership Program, Oregon Health and Science University, School of Nursing, Portland, OR, USA
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Harder SJ, Mathis H, Warsi M, Odedosu K, Hanna RC, Chu ES. Engineering a Clinical Microsystem to Decrease Workplace Violence for Medically and Psychiatrically Concurrently Decompensated Patients. Jt Comm J Qual Patient Saf 2023; 49:53-61. [PMID: 36456435 DOI: 10.1016/j.jcjq.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hospitalized medical patients with concurrently decompensated psychiatric and medical conditions experience worse clinical outcomes. Health care providers caring for this patient population are at increased risk of workplace violence. The authors sought to understand the effects of a clinical microsystem specifically designed to care for patients too psychiatrically ill for medical units and too medically ill for psychiatry units. METHODS The research team performed a quality improvement study in which a medicine-psychiatry co-managed clinical microsystem incorporating high performance teamwork principles was engineered in an urban academic medical center to improve patient and staff safety, as well as operational outcomes. Poisson regression was performed to determine differences between workplace violence events, falls, 30-day emergency department (ED) revisits, and hospital readmissions, comparing the baseline period to the intervention period. RESULTS There were 321 patients discharged in the baseline period and 310 during the intervention period. Workplace violence events decreased by 65.6% (incidence rate ratio [IRR] 0.34, 95% confidence interval [CI] 0.20-0.57, p < 0.001) after implementation of the clinical microsystem when compared to the baseline period. The rate of ED utilization at 30 days postdischarge also decreased from 30.6% at baseline to 21.0% postintervention (adjusted odds ratio [aOR] 0.60, 95% CI 0.42-0.87, p = 0.006). No differences were detected in falls and 30-day readmissions. CONCLUSION For patients with concurrently decompensated medical and psychiatric conditions, the incidence of workplace violence and postdischarge ED utilization can be improved by creating a clinical microsystem that integrates changes to both the physical environment and teamwork processes.
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Radhakrishnan NS, Lukose K, Cartwright R, Sleiman A, Matey N, Lim D, LeGault T, Pollard S, Gravina N, Southwick FS. Prospective application of the interdisciplinary bedside rounding checklist 'TEMP' is associated with reduced infections and length of hospital stay. BMJ Open Qual 2022; 11:bmjoq-2022-002045. [PMID: 36588303 PMCID: PMC9723909 DOI: 10.1136/bmjoq-2022-002045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/05/2022] [Indexed: 12/09/2022] Open
Abstract
Protocols that enhance communication between nurses, physicians and patients have had a variable impact on the quality and safety of patient care. We combined standardised nursing and physician interdisciplinary bedside rounds with a mnemonic checklist to assure all key nursing care components were modified daily. The mnemonic TEMP allowed the rapid review of 11 elements. T stands for tubes assuring proper management of intravenous lines and foleys; E stands for eating, exercise, excretion and sleep encouraging a review of orders for diet, exercise, laxatives to assure regular bowel movements, and inquiry about sleep; M stands for monitoring reminding the team to review the need for telemetry and the frequency of vital sign monitoring as well as the need for daily blood tests; and P stands for pain and plans reminding the team to discuss pain medications and to review the management plan for the day with the patient and family. Faithful implementation eliminated central line-associated bloodstream infections and catheter-associated urinary tract infections and resulted in a statistically significant reduction in average hospital length of stay of 13.3 hours, one unit achieving a 23-hour reduction. Trends towards reduced 30-day readmissions (20% down to 10%-11%) were observed. One unit improved the percentage of patients who reported nurses and doctors always worked together as a team from a 56% baseline to 75%. However, the combining of both units failed to demonstrate statistically significant improvement. Psychologists well versed in implementing behavioural change were recruiting to improve adherence to our protocols. Following training physicians and nurses achieved adherence levels of over 70%. A high correlation (r2=0.69) between adherence and reductions in length of stay was observed emphasising the importance of rigorous training and monitoring of performance to bring about meaningful and reliable improvements in the efficiency and quality of patient care.
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Affiliation(s)
- Nila S Radhakrishnan
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Lukose
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Richard Cartwright
- Office of Clinical Quality and Patient Safety, University of Florida Health, Gainesville, Florida, USA
| | - Andressa Sleiman
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Nicholas Matey
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Duke Lim
- Department of Nursing, University of Florida Health, Gainesville, Florida, USA
| | - Tiffany LeGault
- Department of Nursing, University of Florida Health, Gainesville, Florida, USA
| | - Sapheria Pollard
- Department of Nursing, University of Florida Health, Gainesville, Florida, USA
| | - Nicole Gravina
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Frederick S Southwick
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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Restivo V, Minutolo G, Battaglini A, Carli A, Capraro M, Gaeta M, Odone A, Trucchi C, Favaretti C, Vitale F, Casuccio A. Leadership Effectiveness in Healthcare Settings: A Systematic Review and Meta-Analysis of Cross-Sectional and Before-After Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10995. [PMID: 36078706 PMCID: PMC9518077 DOI: 10.3390/ijerph191710995] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
To work efficiently in healthcare organizations and optimize resources, team members should agree with their leader's decisions critically. However, nowadays, little evidence is available in the literature. This systematic review and meta-analysis has assessed the effectiveness of leadership interventions in improving healthcare outcomes such as performance and guidelines adherence. Overall, the search strategies retrieved 3,155 records, and 21 of them were included in the meta-analysis. Two databases were used for manuscript research: PubMed and Scopus. On 16th December 2019 the researchers searched for articles published in the English language from 2015 to 2019. Considering the study designs, the pooled leadership effectiveness was 14.0% (95%CI 10.0-18.0%) in before-after studies, whereas the correlation coefficient between leadership interventions and healthcare outcomes was 0.22 (95%CI 0.15-0.28) in the cross-sectional studies. The multi-regression analysis in the cross-sectional studies showed a higher leadership effectiveness in South America (β = 0.56; 95%CI 0.13, 0.99), in private hospitals (β = 0.60; 95%CI 0.14, 1.06), and in medical specialty (β = 0.28; 95%CI 0.02, 0.54). These results encourage the improvement of leadership culture to increase performance and guideline adherence in healthcare settings. To reach this purpose, it would be useful to introduce a leadership curriculum following undergraduate medical courses.
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Affiliation(s)
- Vincenzo Restivo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Giuseppa Minutolo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Alberto Battaglini
- Vaccines and Clinical Trials Unit, Department of Health Sciences, University of Genova, Via Antonio Pastore 1, 16132 Genova, Italy
| | - Alberto Carli
- Santa Chiara Hospital, Largo Medaglie d’oro 9, 38122 Trento, Italy
| | - Michele Capraro
- School of Public Health, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Maddalena Gaeta
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy
| | - Cecilia Trucchi
- Planning, Epidemiology and Prevention Unit, Liguria Health Authority (A.Li.Sa.), IRCCS San Martino Hospital, Largo R. Benzi 10, 16132 Genoa, Italy
| | - Carlo Favaretti
- Centre on Leadership in Medicine, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy
| | - Francesco Vitale
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
| | - Alessandra Casuccio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, Via del Vespro 133, 90127 Palermo, Italy
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Closer to or Farther away from an Ideal Model of Care? Lessons Learned from Geographic Cohorting. J Gen Intern Med 2022; 37:3162-3165. [PMID: 35415791 PMCID: PMC9005021 DOI: 10.1007/s11606-022-07560-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
Geographic "cohorting," "co-location," "regionalization," or "localization" refers to the assignation of a hospitalist team to a specific inpatient unit. Its benefits may be related to the formation of a team and the additional interventions like interdisciplinary rounding that the enhanced proximity facilitates. However, cohorting is often adopted in isolation of the bundled approach within which it has proven beneficial. Cohorting may also be associated with unintended consequences such as increased interruptions and increased indirect care time. Institutions may increase patient loads in anticipation of the efficiency gained by cohorting-leading to further increases in interruptions and time away from the bedside. Fragmented attention and increases in indirect care may lead to a perception of increased workload, errors, and burnout. As hospital medicine evolves, there are lessons to be learned by studying cohorting. Institutions and inpatient units should work in synergy to shape the day-to-day work which directly affects patient and clinician outcomes-and ultimately culminates in the success or failure of the parent organization. Such synergy can manifest in workflow design and metric selection. Attention to workloads and adopting the principles of continuous quality improvement are also crucial to developing models of care that deliver excellent care.
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Orewa GN, Feldman SS, Hearld KR, Kennedy KC, Hall AG. Using Accountable Care Teams to Improve Timely Discharge: A Pilot Study. Qual Manag Health Care 2022; 31:22-27. [PMID: 34354033 DOI: 10.1097/qmh.0000000000000320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Hospitals worldwide are faced with the problem of discharging patients on time. Delayed discharge creates domino effects with significant implications for hospitals. The accountable care team (ACT) is a multidisciplinary, unit-based approach to identifying opportunities to improve patient care and address inefficiencies in care delivery and throughput, including assuring timely discharges. In response to concerns about emergency department boarding times and delays in timely discharge, the ACT recommended a set of strategies to improve communication across team members and to reduce wait times for transportation within and outside the hospital. Collectively these strategies were thought to increase the proportion of patients discharged on time. In this article, we describe and assess changes in timely discharge resulting from the implementation of strategies recommended by the ACT. METHODS This study uses a retrospective, quasi-experimental design to compare the percentage of discharges by 1 pm of hospital units implementing the ACT intervention to those units not implementing the intervention. Median discharge time was compared pre- and post-implementation using the Wilcoxon rank sum test. Difference-in-differences modeling was employed to assess whether changes in the percentage of discharges by 1 pm differed between units implementing the intervention and units not implementing the intervention. RESULTS One month post-implementation, the percentage discharged by 1 pm was statistically significantly higher for units implementing the intervention (53.6%) compared with comparison units (22.5%, t = -4.48, P < .01). Statistically significant differences in the percentage discharged by 1 pm were also seen at 3 and 6 months post-implementation. The median discharge time showed a statistically significant decrease by 77 minutes from the baseline to intervention period ( P < .01). CONCLUSION The result from the study suggests that ACTs can be used to develop approaches aimed at improving patient care in general, and discharge efficiencies in particular. Health care organizations are encouraged to utilize and then evaluate the specific activities of multidisciplinary teams aimed at developing recommendations for practice improvement.
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Affiliation(s)
- Gregory N Orewa
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, United States of America (Mr Orewa and Drs Feldman, Hearld, and Hall); and UAB Hospital Medicine, University of Alabama at Birmingham, Birmingham (Dr Kennedy)
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Loertscher L, Wang L, Sanders SS. The impact of an accountable care unit on mortality: an observational study. J Community Hosp Intern Med Perspect 2021; 11:554-557. [PMID: 34211668 PMCID: PMC8221162 DOI: 10.1080/20009666.2021.1918945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Despite enthusiasm for inpatient ward redesign, coordinated models require high effort with uncertain return on investment. Objective: We aimed to reduce mortality and achieve a benchmark of zero preventable deaths by committing to an interprofessional model, including partnered nurse-physician unit leadership, geographic localization, and structured interdisciplinary bedside rounds (SIBR). Methods: An observational pre-post design with 5-year follow-up studied the transition of a medical unit to an Accountable Care Unit (ACU). This geographic model enables partnered nurse-physician leadership and patient-centered workflows, including daily interdisciplinary bedside rounds. Potentially additive or confounding hospital-wide safety initiatives were tracked. Yearly mortality was compared using multivariable logistic regression and reported as odds ratio (OR). For the pre-specified goal of no preventable deaths, we report unexpected deaths, defined as those occurring without documentation of comfort as the goal of care. Results: 12,158 inpatients (55.1% female, mean [sd] age 62.2 [19.7]) were observed over 6 years. Reduction in the risk-adjusted mortality was observed following ACU implementation, with Year 2 significantly lower than the pre-implementation year (adjusted odds ratio [aOR] = 0.58 [0.35–0.94]). Risk-adjusted mortality was similar in Year 3 (aOR = 0.64 [0.39–1.0]) but returned to baseline for Years 4 and 5. Unexpected deaths reached zero in Year 3 and plateaued in Years 4 and 5 at a rate below pre-implementation year (~0.1% vs. 0.38%). Conclusions: A geographic ACU with nurse-physician partnered leadership and daily structured interdisciplinary bedside rounds can reduce total and unexpected mortality. However, maintenance requires constant effort and, in the real world, multiple confounders complicate study.
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Affiliation(s)
- Laura Loertscher
- Clinical Faculty, Department of Medicine, Providence St. Vincent Medical Center Internal Medicine Residency, Portland, Oregon, USA
| | - Lian Wang
- Center for Cardiovascular Analytics, Research and Data Science (CARDS), Medical Data Research Center (MDRC, Providence Heart Institute, Providence St. Joseph Health, Portland, Oregon, USA
| | - Shelley Schoepflin Sanders
- Clinical Faculty, Department of Medicine, Providence St. Vincent Medical Center Internal Medicine Residency, Portland, Oregon, USA
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O'Leary KJ, Manojlovich M, Johnson JK, Estrella R, Hanrahan K, Leykum LK, Smith GR, Goldstein JD, Williams MV. A Multisite Study of Interprofessional Teamwork and Collaboration on General Medical Services. Jt Comm J Qual Patient Saf 2020; 46:667-672. [PMID: 33228852 DOI: 10.1016/j.jcjq.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/08/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Teamwork and collaboration are essential to providing high-quality care. Prior research has found discrepancies between nurses' and physicians' perceptions in operating rooms, ICUs, and labor and delivery units. Less is known about health care professionals' perceptions of teamwork and collaboration on general medical services. METHODS This cross-sectional study included nurses, nurse assistants, and physicians working on general medical services in four mid-sized hospitals. Researchers assessed teamwork climate using the Safety Attitudes Questionnaire and asked respondents to rate the quality of collaboration experienced with their own and other professional categories. RESULTS Data for 380 participants (80 hospitalists, 13 resident physicians, 193 nurses, and 94 nurse assistants) were analyzed. Hospitalists had the highest median teamwork climate score (83.3, interquartile range [IQR] = 72.3-91.1), and nurses had the lowest (78.6, IQR = 69.6-87.5), but the difference was not statistically significant (p = 0.42). Median teamwork climate scores were significantly different across the four sites (highest = 83.3, IQR = 75.0-91.1; lowest = 76.8, IQR = 66.7-88.4; p = 0.003). Ratings of the quality of collaboration differed significantly based on professional category. Specifically, 63.3% (50/79) of hospitalists rated the quality of collaboration with nurses as high or very high, while 48.7% (94/193) of nurses rated the quality of collaboration with hospitalists as high or very high. CONCLUSION This study found significant differences in perceptions of teamwork climate across sites and in collaboration across professional categories on general medical services. Given the importance in providing high-quality care, leaders should consider conducting similar assessments to characterize teamwork and collaboration on general medical services within their own hospitals.
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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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Beaird G, Baernholdt M, Byon HD, White KR. Interprofessional rounding design features and associations with collaboration and team effectiveness. J Interprof Care 2020; 35:343-351. [PMID: 32530333 DOI: 10.1080/13561820.2020.1768058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Multiple models of interprofessional rounding (IPR) exist. However, researchers find mixed effects for the impact of IPR, pointing to the possibility that variations in design may influence the effectiveness of the practice. We explored whether IPR design variations (location, use of script, and role of the leader) are associated with team collaboration (partnership and cooperation) and team effectiveness as perceived by practitioners and patients (i.e., patient inclusion). A cross-sectional, survey-based method design was used targeting practitioners on 15 different hospital units at two academic health centers. Routinely collected Hospital Consumer Assessment of Healthcare Practitioners and Systems scores were used to capture patients' perceptions. Statistical methods included multilevel modeling with moderation analysis. There were several significant relationships among design, team collaboration, and team effectiveness. For the design, role of the leader and use of a script had a significant positive association with cooperation. Practitioners' perceptions of team effectiveness were associated with use of script, and cooperation moderated the relationships between practitioners' perceptions of team effectiveness and location, as well as the role of the leader. There was a significant inverse relationship between cooperation and patient inclusion. Results can inform organizations that are exploring, implementing, or improving IPR as well as considering alternative ways to evaluate their practices.
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Affiliation(s)
- Genevieve Beaird
- Department of Family and Community Health, Virginia Commonwealth University School of Nursing
| | | | - Ha Do Byon
- University of Virginia School of Nursing, USA
| | - Kenneth R White
- Office of the Dean, Strategic Partnerships & Innovation, University of Virginia School of Nursing
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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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Beaird G, Baernholdt M, White KR. Perceptions of interdisciplinary rounding practices. J Clin Nurs 2020; 29:1141-1150. [PMID: 31889345 DOI: 10.1111/jocn.15161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 12/05/2019] [Accepted: 12/20/2019] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore practitioner perspectives on the facilitators, barriers and outcomes associated with interdisciplinary rounding practices (IDR). BACKGROUND Interdisciplinary rounding practices is frequently used intervention to promote collaboration and patient-centred care in hospital units. Previous research supports that having IDR in place can lead to greater perceptions of collaboration and practitioner satisfaction; however, the practice does not always lead to better outcomes for patients. For IDR to be successful, unit leadership needs a greater understanding of facilitators and barriers as perceived by team members. At both the individual and organisational levels, there is limited understanding on what influences the success of IDR. This study seeks to explore factors influencing interdisciplinary rounding and perceived outcomes by team members. DESIGN A quasi-qualitative design was used to address the aim of this study. Four open-ended questions were emailed to practitioners across fifteen units in two academic health centres. All units identified as having IDR in place. METHODS A directed content analysis of practitioner responses was used to identify key themes. The Standards for Reporting Qualitative Research checklist was consulted for reporting of the results. RESULTS A total of 141 practitioners responded to the open-ended questions. Three themes emerged from the data: (a) setting the stage; (b) the work of the team; and 3) benefits to patient care. CONCLUSIONS The study provides a nuanced perspective of facilitators, barriers and potential outcomes associated with IDR. Future research is needed to gain additional perspective on the role the organisation plays in promoting a healthy workplace environment as well as providing patient-centred care. RELEVANCE TO CLINICAL PRACTICE This study provides insight into facilitators and barriers to conducting interdisciplinary rounding practices in the inpatient setting. Results can be useful to unit leaders and staff that advocate for more collaborative and patient-centred rounding practices.
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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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16
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Will KK, Johnson ML, Lamb G. Team-Based Care and Patient Satisfaction in the Hospital Setting: A Systematic Review. J Patient Cent Res Rev 2019; 6:158-171. [PMID: 31414027 DOI: 10.17294/2330-0698.1695] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose Limited research examining the relationship between team-based models of care and patient satisfaction in the hospital setting is available. The purpose of this literature review was to explore this relationship as well as the relationships between team composition, team-based interventions, patient satisfaction, and other outcomes of care when measured as part of the study. Methods A systematic appraisal of research studies published through February 2017 was conducted using PubMed, Cochrane Library, CINAHL, Embase, Ovid, gray literature and Google Scholar. Inclusion criteria were 1) experimental (randomized control trials), quasi-experimental, or non-experimental (cross-sectional) study design; 2) team-based care interventions; 3) hospital setting; 4) patient satisfaction measured as an outcome; and 5) published in English. Results The literature search yielded 15,247 citations. In total, 142 articles were retrieved for full-text screening; 21 studies met inclusion criteria. Overall, 57% of the studies identified a statistically significant improvement in patient satisfaction associated with team-based care. Team-based care interventions ranged from single team activities such as multidisciplinary rounds to comprehensive team-based models of care. Patient satisfaction scores were greater with teams that had more than two professions and more comprehensive team-based models. About one-quarter of studies that measured patient satisfaction and at least one additional outcome demonstrated improvement in both. Conclusions Team-based care may positively affect patient satisfaction. Team composition and type of team intervention appears to influence the strength of the relationship. Improvements in satisfaction are not consistently accompanied by improvements in other outcomes.
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Affiliation(s)
- Kristen K Will
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | | | - Gerri Lamb
- Center for Advancing Interprofessional Practice, Education and Research, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
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Jala S, Giaccari S, Passer M, Bertmar C, Day S, Griffith D, Krause M. "In Safe Hands" - A costly integrated care program with limited benefits in stroke unit care. J Clin Neurosci 2018; 59:84-88. [PMID: 30409533 DOI: 10.1016/j.jocn.2018.10.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 10/03/2018] [Accepted: 10/28/2018] [Indexed: 11/26/2022]
Abstract
Given reported favourable outcomes of accountable care unit models of health care delivery (Taylor et al., 2017; Stein et al., 2015; Kara et al., 2015), the Clinical Excellence Commission of NSW has embraced "In Safe Hands" (ISH) to enhance coordination of care. ISH embraces the structured interdisciplinary bedside round (SIBR) component, for which reported outcomes include reduced length of stay (Taylor et al., 2017; Stein et al., 2015; Kara et al., 2015), possible reduction in overall costs of care (Kara et al., 2015), and enhanced patient and staff satisfaction (O'Leary et al., 2011). It is not yet clear whether the benefits of such a model are translatable to the Australian Health Care System (Hunyh et al., 2016) and/or established units with an already strong multi-disciplinary approach to patient care. The purpose of this prospective cohort study of 200 participants was to assess the effect(s) of implementation of ISH in a stroke unit of a tertiary hospital in Sydney, Australia. Data on length of stay, re-admission rates, adverse events, as well as patient and nursing satisfaction, were collected pre and post implementation. There was no significant difference in length of stay in median days (5 (IQR 2-7) versus 4 (IQR 2-6), P = 0.55) or incidence of adverse events (10% versus 12%, P = 0.82). Stroke outcome disability scores were not affected by the intervention. There were no significant differences overall in reported patient and nursing satisfaction. Implementation of the ISH program cost approximately AUD$ 1805/week (USD$ 1365) in wages. The ISH program was a costly intervention of limited benefit in a well-established acute stroke unit. We here discuss potential reasons for the failure of this intervention to achieve its primary aim in this setting.
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Affiliation(s)
- Sheila Jala
- Neurology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
| | - Sarah Giaccari
- Physiotherapy Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Melissa Passer
- Neurology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Carin Bertmar
- Neurology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Susan Day
- Neurology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Dayna Griffith
- Neurology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Martin Krause
- Neurology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia; University of Sydney, Northern Clinical School, St Leonards, NSW 2065, Australia
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Hendricks S, LaMothe VJ, Halstead JA, Taylor J, Ofner S, Chase L, Dunscomb J, Chael A, Priest C. Fostering interprofessional collaborative practice in acute care through an academic-practice partnership. J Interprof Care 2018; 32:613-620. [DOI: 10.1080/13561820.2018.1470498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Susan Hendricks
- Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Virginia Julie LaMothe
- Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Judith A. Halstead
- Commission for Nursing Education Accreditation, National League for Nursing, Washington, DC, USA
| | - Jennifer Taylor
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Susan Ofner
- Department of Biostatistics, Indiana University School of Nursing, Indianapolis, IN, USA
| | - Linda Chase
- Indiana University Health, Indianapolis, IN, USA
| | | | - Amy Chael
- Indiana University Health, Indianapolis, IN, USA
| | - Chad Priest
- Department of Family Medicine, Indiana Regional Chief Executive, American Red Cross, Washington, DC, USA
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Kara A, Johnson CS, Hui SL, Kashiwagi D. Hospital-Based Clinicians' Perceptions of Geographic Cohorting: Identifying Opportunities for Improvement. Am J Med Qual 2017; 33:303-312. [PMID: 29241347 DOI: 10.1177/1062860617745123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Members of the Society of Hospital Medicine were surveyed about geographic cohorting (GCh); 369 responses were analyzed, two thirds of which were from GCh participants. Improved collaboration with the bedside nurse, increased nonclinical interactions, decreased paging interruptions, and improved efficiency were perceived by >50%. Narrowed clinical expertise, increased fragmentation, increased face-to-face interruptions, and an adverse impact on camaraderie within the hospitalist group were reported by 25% to 50%. Academic practices were associated with positive perceptions while higher patient loads were associated with negative perceptions. Comments on GCh benefits invoked improvements in (1) interprofessional collaboration, (2) efficiency, (3) patient-centeredness, (4) nursing satisfaction, and (5) GCh mediated facilitation of other interventions. GCh downsides included (1) professional and personal dissatisfaction, (2) concerns about providing suboptimal care, and (3) implementation barriers. GCh is receiving attention. Although it facilitates important benefits, it is perceived to mediate unintended consequences, which should be addressed in redesign efforts.
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Affiliation(s)
- Areeba Kara
- 1 ASPIRE scholar, Department of General Internal Medicine, IU School of Medicine, Inpatient Medicine Indiana University Health Methodist Hospital, Indianapolis, IN
| | - Cynthia S Johnson
- 2 Department of Biostatistics, IU School of Medicine, Indianapolis, IN
| | - Siu L Hui
- 3 Regenstrief Institute, Indianapolis, IN
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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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22
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Dunn AS, Reyna M, Radbill B, Parides M, Colgan C, Osio T, Benson A, Brown N, Cambe J, Zwerling M, Egorova N, Kaplan H. The Impact of Bedside Interdisciplinary Rounds on Length of Stay and Complications. J Hosp Med 2017; 12:137-142. [PMID: 28272588 DOI: 10.12788/jhm.2695] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Communication among team members within hospitals is typically fragmented. Bedside interdisciplinary rounds (IDR) have the potential to improve communication and outcomes through enhanced structure and patient engagement. OBJECTIVE To decrease length of stay (LOS) and complications through the transformation of daily IDR to a bedside model. DESIGN Controlled trial. SETTING 2 geographic areas of a medical unit using a clinical microsystem structure. PATIENTS 2005 hospitalizations over a 12-month period. INTERVENTIONS A bedside model (mobile interdisciplinary care rounds [MICRO]) was developed. MICRO featured a defined structure, scripting, patient engagement, and a patient safety checklist. MEASUREMENTS The primary outcomes were clinical deterioration (composite of death, transfer to a higher level of care, or development of a hospital-acquired complication) and length of stay (LOS). Patient safety culture and perceptions of bedside interdisciplinary rounding were assessed pre- and postimplementation.. RESULTS There was no difference in LOS (6.6 vs 7.0 days, P = 0.17, for the MICRO and control groups, respectively) or clinical deterioration (7.7% vs 9.3%, P = 0.46). LOS was reduced for patients transferred to the study unit (10.4 vs 14.0 days, P = 0.02, for the MICRO and control groups, respectively). Nurses and hospitalists gave significantly higher scores for patient safety climate and the efficiency of rounds after implementation of the MICRO model. LIMITATIONS The trial was performed at a single hospital. CONCLUSIONS Bedside IDR did not reduce overall LOS or clinical deterioration. Future studies should examine whether comprehensive transformation of medical units, including co-leadership, geographic cohorting of teams, and bedside interdisciplinary rounding, improves clinical outcomes compared to units without these features. Journal of Hospital Medicine 2017;12:137-142.
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Affiliation(s)
- Andrew S Dunn
- Division of Hospital Medicine, Mount Sinai Health System, New York, New York, USA
| | - Maria Reyna
- Division of Hospital Medicine, Mount Sinai Health System, New York, New York, USA
| | | | - Michael Parides
- Department of Population Health Science and Policy, Mount Sinai Medical Center, New York, New York, USA
| | | | - Tobi Osio
- Department of Nursing, Mount Sinai Health System, New York, New York, USA
| | - Ari Benson
- Department of Medicine, Mount Sinai Health System, New York, New York, USA
| | - Nicole Brown
- Department of Medicine, Mount Sinai Health System, New York, New York, USA
| | - Joy Cambe
- Department of Medicine, Mount Sinai Health System, New York, New York, USA
| | - Margo Zwerling
- Department of Medicine, Mount Sinai Health System, New York, New York, USA
| | - Natalia Egorova
- Department of Population Health Science and Policy, Mount Sinai Medical Center, New York, New York, USA
| | - Harold Kaplan
- Department of Population Health Science and Policy, Mount Sinai Medical Center, New York, New York, USA
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Burdick K, Kara A, Ebright P, Meek J. Bedside Interprofessional Rounding: The View From the Patient's Side of the Bed. J Patient Exp 2017; 4:22-27. [PMID: 28725857 PMCID: PMC5513664 DOI: 10.1177/2374373517692910] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Bedside interprofessional rounding is gaining ground as a means to improve collaboration and patient outcomes, yet little is known regarding patients’ perceptions of the practice. Methods: This descriptive study used individual patient interviews to elicit views on interprofessional rounding from 35 patients at a large, urban hospital. Results: The findings identified three major categories: 1) about the rounding process; 2) clinical information; and 3) the impact/value of bedside inter-professional rounding. Discussion: Intentionally eliciting and responding to our patients’ views of interprofessional rounding may help us design methods that are patient centered and effective.
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Affiliation(s)
- Kailee Burdick
- Indiana University School of Nursing, Indiana University, Indianapolis, IN, USA
| | - Areeba Kara
- Inpatient Medicine, Indiana University Health, Indiana University, Indianapolis, IN, USA
| | - Patricia Ebright
- Indiana University School of Nursing, Indiana University, Indianapolis, IN, USA
| | - Julie Meek
- Indiana University School of Nursing, Indiana University, Indianapolis, IN, USA
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Abstract
OBJECTIVES To explore how partnerships among private, nonprofit, and public organizations can be instrumental in addressing 21st century health care challenges. DATA SOURCES Peer-reviewed studies and guidelines, journal articles, books, websites, and personal communication. CONCLUSION Given the complexity of the health care environment and the need to transform the system, individuals and organizations will need to form partnerships that result in improved quality of care and decreased cost. Some recent initiatives have been successful and are included in this article. IMPLICATIONS FOR NURSING PRACTICE In many communities and at the national level, there are agencies and organizations that are working independently, yet they have overlapping goals and the same intent. They compete for the same financial and human resources whether in academia, the care delivery sector, or non-profit associations. In the cancer care world, interprofessional teams are essential, yet much care is still delivered in silos. There are redundant patient advocacy organizations even for some of the less common cancers. Partnerships and collaboration will take new forms and require new skill sets in the future.
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