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

1Northwestern University Feinberg School of Medicine, Chicago, IL
2Northwestern University Feinberg School of Medicine, Chicago, IL
3Northwestern Memorial Hospital, Chicago, IL
4Northwestern Memorial Hospital, 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: 104

Background:

Research reveals deficiencies in teamwork on medical teaching units. The aim of this study was to assess the impact of an intervention, structured interdisciplinary rounds (SlDRs), on hospital care providers' ratings of collaboration and teamwork and on hospital length of stay (LOS) and cost.

Methods:

The study was a controlled trial comparing an intervention medical teaching unit with a similar control unit at an urban 897‐bed teaching hospital. The intervention, SIDR, combined a structured formal 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, 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 senior residents 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. 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 5‐point ordinal scale. We also assessed the teamwork and safety climate using the Safety Attitudes Questionnaire. Multiple linear regression analyses assessed the impact on LOS and cost for patients admitted in the 6 months after implementation of SIDR.

Results:

SIDR occurred each weekday during the study period and lasted a mean 33.5 ± 5.7 minutes. Overall, 92% of patients on the unit were discussed each day, and attendance exceeded 82% for each discipline. One hundred and sixty‐one of 173 eligible providers (93%) completed the survey. Although resident physicians on each unit rated the quality of communication and collaboration with nurses as similarly high, a greater percentage of nurses gave high ratings to the quality of collaboration with resident physicians on the intervention unit compared with on the control unit (74% vs. 44%, P = 0.02). Providers on the intervention unit rated the teamwork climate significantly higher than did those on the control unit (82.8 ± 11.5 vs. 77.9 ± 12.2; P = 0.01). The difference was mainly 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). Adjusted LOS and hospital costs were not significantly different between units.

Conclusions:

SIDR had a positive effect on providers' ratings of collaboration and teamwork on a medical teaching unit, particularly among nurses. Further study is required to assess the impact of SIDR on patient safety measures.

Author Disclosure:

K. O'Leary, none; D. Wayne, none; C. Haviley, none; M. Slade, none; J. Lee, none; M. Williams, none.

To cite this abstract:

O'Leary K, Wayne D, Haviley C, Slade M, Lee J, Williams M. Improving Teamwork: Impact of Structured Interdisciplinary Rounds on a Medical Teaching Unit. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 104. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/improving-teamwork-impact-of-structured-interdisciplinary-rounds-on-a-medical-teaching-unit/. Accessed September 20, 2019.

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