ABSTRACT
BACKGROUND
Geographical localization of hospitalist teams to nursing units may have an impact on the quality of inpatient care. The perceptions of individuals who provide patient care in a localized model of care have not been adequately studied.
OBJECTIVE
To determine the impact of geographic localization of hospitalist teams by evaluating the perceptions of hospitalists (faculty and physician assistants) localized to a single nursing unit and the nurses who staffed that unit.
DESIGN
Focus group study.
SUBJECTS
Six hospitalist faculty and three hospitalist physician assistants who provided patient care while localized to a single nursing unit, as well as 29 nurses who staffed the nursing unit where localization occurred.
MAIN MEASURES
Themes that emerged from grounded theory analysis of focus group transcripts.
KEY RESULTS
Participants perceived an overall positive impact of localization on the quality of patient care they provide and their workflow. The positive impact was mediated through proximity to patients and between members of the healthcare team, as well as through increased communication, decreased wasted time and increased teamwork. The participants also identified increased interruptions, variability in patient flow, mismatches in specialization and perverse incentives as mediating factors leading to unintended consequences. A model emerged that can inform future deployment and evaluation of localization interventions.
CONCLUSIONS
Geographical localization of hospitalist teams is perceived to be desirable by both hospitalists and nurses. Others who attempt localization could use our conceptual model as a guide to maximize the benefit and minimize the unintended consequences of this intervention.
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Acknowledgements
The authors would like to thank the section of hospital medicine at the Medical College of Wisconsin and the nursing staff on 9NT Froedtert Hospital for supporting this research.
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None.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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Appendix: Focus group guide
Appendix: Focus group guide
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1.
Is the localization of medical teams desirable? If so/ if not – why?
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2.
What is the impact of localization of medical teams on quality of inpatient care?
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3.
What is the impact of localization of medical teams on your workflow?
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4.
What is the impact of localization of medical teams on your workload?
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5.
What is the impact of localization of medical teams on your interaction with other members of the health care team?
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6.
Can you describe a time that the dispersal model of medical teams resulted in an adverse patient event? A near miss? What specific aspects contributed to adverse events?
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7.
Describe certain situations where localization of medical teams had an adverse impact on patient care?
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8.
How would you define optimal localization of medical teams?
Quality: Defined as meeting the 6 aims of IOM – safety, effectiveness, efficiency, equity, patient centeredness and timeliness.
Workflow: defines as the sequences of tasks or interruptions, coherence, appropriate prioritization etc.
Workload – defined as the subjective feeling of how hard you work.
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Singh, S., Fletcher, K.E. A Qualitative Evaluation of Geographical Localization of Hospitalists: How Unintended Consequences May Impact Quality. J GEN INTERN MED 29, 1009–1016 (2014). https://doi.org/10.1007/s11606-014-2780-6
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DOI: https://doi.org/10.1007/s11606-014-2780-6