Journal of General Internal Medicine

, Volume 25, Issue 8, pp 826–832

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

  • Kevin J. O’Leary
  • Diane B. Wayne
  • Corinne Haviley
  • Maureen E. Slade
  • Jungwha Lee
  • Mark V. Williams
Original Research

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.

KEY WORDS

teamwork SIDR interdisciplinary rounds communication 

References

  1. 1.
    Joint Commission on Accreditation of Healthcare Organizations. Sentinel Event Statistics. http://www.jointcommission.org/SentinelEvents/Statistics/. Accessed March 22, 2010.
  2. 2.
    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.CrossRefPubMedGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med. 2004;79(2):186–94.CrossRefPubMedGoogle Scholar
  5. 5.
    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.PubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    Thomas EJ, Sexton JB, Helmreich RL. Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med. 2003;31(3):956–9.CrossRefPubMedGoogle Scholar
  8. 8.
    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.Google Scholar
  9. 9.
    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.Google Scholar
  10. 10.
    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.Google Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    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.PubMedGoogle Scholar
  13. 13.
    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.CrossRefPubMedGoogle Scholar
  14. 14.
    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.PubMedGoogle Scholar
  15. 15.
    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.Google Scholar
  16. 16.
    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.PubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar
  19. 19.
    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.Google Scholar
  20. 20.
    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.Google Scholar
  21. 21.
    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.CrossRefPubMedGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    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.CrossRefPubMedGoogle Scholar
  25. 25.
    HCUP Clinical Classification Software [computer program]. Version: Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed March 22, 2010.
  26. 26.
    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.PubMedGoogle Scholar
  27. 27.
    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.PubMedGoogle Scholar
  28. 28.
    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.CrossRefPubMedGoogle Scholar
  29. 29.
    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.PubMedGoogle Scholar
  30. 30.
    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.CrossRefPubMedGoogle Scholar
  31. 31.
    Rosenstein AH. Original research: nurse-physician relationships: impact on nurse satisfaction and retention. Am J Nurs. 2002;102(6):26–34.PubMedGoogle Scholar
  32. 32.
    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.CrossRefPubMedGoogle Scholar
  33. 33.
    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.PubMedGoogle Scholar
  34. 34.
    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.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Kevin J. O’Leary
    • 1
  • Diane B. Wayne
    • 2
  • Corinne Haviley
    • 3
  • Maureen E. Slade
    • 3
  • Jungwha Lee
    • 4
  • Mark V. Williams
    • 1
  1. 1.Division of Hospital MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Division of General Internal MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  3. 3.Northwestern Memorial HospitalChicagoUSA
  4. 4.Department of Preventative MedicineNorthwestern University Feinberg School of MedicineChicagoUSA

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