Improving Teamwork: Impact of Structured Interdisciplinary Rounds on a Hospitalist Unit

1Northwestern University Feinberg School of Medicine, Chicago, IL
2Northwestern Memorial Hospital, Chicago, IL
3Northwestern Memorial Hospital, Chicago, IL
4Northwestern University Feinberg School of Medicine, Chicago, IL
5Northwestern University Feinberg School of Medicine, Chicago, IL
6Northwestern University Feinberg School of Medicine, Chicago, IL

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 103

Background:

Research reveals deficiencies in teamwork on medical units involving hospitalists. The aims of this study were to assess the impact of an intervention, structured interdisciplinary rounds (SlDRs), on nurses' ratings of collaboration and teamwork and on hospital length of stay (LOS) and cost.

Methods:

The study was a controlled trial involving an intervention and control hospitalist unit at an urban 897‐bed teaching hospital. The intervention, SIDR, combined a structured format for communication with a forum for regular interdisciplinary meetings. An interdisciplinary working group met weekly for 6 weeks prior to implementation to determine the optimal timing, frequency, and location for SIDR. Based on the working group's recommendation, the SIDR took place each weekday at 11:00 AM in the unit conference room and lasted approximately 30 minutes. The nurse manager and a unit medical director co‐led SIDR each day, which was attended by all nurses and hospitalists caring for patients on the unit, as well as the pharmacist, social worker, and case manager assigned to the unit. Providers used a structured communication tool during SIDR, which was modeled after prior research demonstrating the benefit of daily goals‐of‐care forms. Nurses working on the intervention and control units during the study period were administered a survey 16 weeks after implementation of SIDR. We asked nurses to rate the quality of communication and collaboration with hospitalists, using a 5‐point ordinal scale. We also assessed teamwork and the safety climate using the Safety Attitudes Questionnaire. Hospitalists worked on both study units, precluding our ability to assess differences in their ratings of collaboration and teamwork. Multiple linear regression analyses assessed the impact on LOS and cost for patients admitted in the 6 months after implementation of SIDR using both a concurrent and historic control.

Results:

SIDR occurred each weekday on the intervention unit and lasted a mean 27.7 ± 4.6 minutes. Overall, 86% of patients on the 30‐bed unit were discussed each day, and attendance exceeded 85% for each discipline. Forty‐nine of 58 nurses (84%) completed surveys. A larger percentage of nurses rated the quality of communication and collaboration with hospitalists as high or very high on the intervention unit compared to the control unit (80% vs. 54%; P = 0.05). Nurses rated the teamwork and safety climate significantly higher on the intervention unit than on the control unit (81.2 ± 16.5 vs. 65.4 ± 20.6, P = 0.008; and 73.4 ± 13.4 vs. 57.0 ± 26.4. P = 0.03 for teamwork and safety climate, respectively). Multiple linear regression analyses demonstrated no difference in the adjusted LOS and an inconsistent effect on cost.

Conclusions:

SIDR had a positive effect on nurses' ratings of collaboration and teamwork on a hospitalist unit yet had no impact on LOS and cost. Further study is required to assess the impact of SIDR on patient safety measures.

Author Disclosure:

K. O'Leary, none; C. Haviley, none; M. Slade, none; H. Shah, none; J. Lee, none; M. Williams, none.

To cite this abstract:

O'Leary K, Haviley C, Slade M, Shah H, Lee J, Williams M. Improving Teamwork: Impact of Structured Interdisciplinary Rounds on a Hospitalist Unit. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 103. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/improving-teamwork-impact-of-structured-interdisciplinary-rounds-on-a-hospitalist-unit/. Accessed September 18, 2019.

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