Association between nurse-physician collaboration and patient outcomes in three intensive care units

Baggs, Judith Gedney; Schmitt, Michael N.; Mushlin, Alvin I.; Mitchell, Pamela H.; Eldredge, Deborah H.; Oakes, David; Hutson, Alan D.

doi:10.1097/00003246-199909000-00045

Cited by 640 publications

(519 citation statements)

References 24 publications

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“…A thorough understanding of attitudes is prerequisite to improving teamwork; yet, tools examining teamwork behaviors in actual practice provide scores that may be more readily linked to important patient safety outcomes. 83,155,202 Unfortunately, these assessments often require extensive rater training to achieve adequate reliability, 105 which can be time consuming and costly. Implementing existing tools, rather than creating new ones, should reduce the cost of tool development so that these resources can be allocated to rater training and implementation.…”

Section: Discussionmentioning

confidence: 99%

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Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

et al. 2013

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OBJECTIVE: Valid teamwork assessment is imperative to determine physician competency and optimize patient outcomes. We systematically reviewed published instruments assessing teamwork in undergraduate, graduate, and continuing medical education in general internal medicine and all medical subspecialties. DATA SOURCES: We searched MEDLINE, MEDLINE In-process, CINAHL and PsycINFO from January 1979 through October 2012, references of included articles, and abstracts from four professional meetings. Two content experts were queried for additional studies. STUDY ELIGIBILITY: Included studies described quantitative tools measuring teamwork among medical students, residents, fellows, and practicing physicians on single or multi-professional (interprofessional) teams. STUDY APPRAISAL AND SYNTHESIS METHODS:Instrument validity and study quality were extracted using established frameworks with existing validity evidence. Two authors independently abstracted 30 % of articles and agreement was calculated. RESULTS: Of 12,922 citations, 178 articles describing 73 unique teamwork assessment tools met inclusion criteria. Interrater agreement was intraclass correlation coefficient 0.73 (95 % CI 0.63-0.81). Studies involved practicing physicians (142, 80 %), residents/fellows (70, 39 %), and medical students (11, 6 %). The majority (152, 85 %) assessed interprofessional teams. Studies were conducted in inpatient (77, 43 %), outpatient (42, 24 %), simulation (37, 21 %), and classroom (13, 7 %) settings. Validity evidence for the 73 tools included content (54, 74 %), internal structure (51, 70 %), relationships to other variables (25, 34 %), and response process (12, 16 %). Attitudes and opinions were the most frequently assessed outcomes. Relationships between teamwork scores and patient outcomes were directly examined for 13 (18 %) of tools. Scores from the Safety Attitudes Questionnaire and Team Climate Inventory have substantial validity evidence and have been associated with improved patient outcomes. LIMITATIONS: Review is limited to quantitative assessments of teamwork in internal medicine. CONCLUSIONS:There is strong validity evidence for several published tools assessing teamwork in internal medicine. However, few teamwork assessments have been directly linked to patient outcomes. 3,4 Recognizing this, the Institute of Medicine, the Joint Commission, the Agency for Healthcare Research and Quality (AHRQ), and others have made teamwork a top priority in their recommendations for improving healthcare. [5][6][7][8][9] Teamwork is also prominently positioned within the American Board of Internal Medicine (ABIM) requirements for maintenance of certification for internists, 10 as well as the Accreditation Council for Graduate Medical Education's core competencies, 11 milestones, 12 and medical student competencies. 13 As such, every physician at the undergraduate, graduate, and continuing professional level must demonstrate competency in teamwork.While there is broad agreement on the imperative to improve teamwork, there is littl...

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Section: Discussionmentioning

confidence: 99%

“…Teamwork tools by Baggs 83,210 and Wheelan 155 show inverse relationships between positive teamwork and mortality rates.…”

Section: Teamwork Tools Associated With Patient Outcomesmentioning

confidence: 99%

Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

et al. 2013

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“…While randomized controlled trials are lacking, observational studies document better patient outcomes are associated with higher ratings of collaboration and teamwork. [23][24][25] Future research should assess whether use of SIDR to improve collaboration also produces improvements in the safety of care and outcomes on inpatient medical units. The majority of providers agreed that SIDR improved patient care as well as the efficiency of their workday and attendance was high among all disciplines.…”

Section: Discussionmentioning

confidence: 99%

Improving teamwork: Impact of structured interdisciplinary rounds on a hospitalist unit

O’Leary

Haviley

Slade

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Effective collaboration and teamwork is essential in providing safe and effective care. Research reveals deficiencies in teamwork on medical units involving hospitalists.OBJECTIVE:The aim of this study was to assess the impact of an intervention, Structured Inter‐Disciplinary Rounds (SIDR), on nurses' ratings of collaboration and teamwork.METHODS:The study was a controlled trial involving an intervention and control hospitalist unit. The intervention, SIDR, combined a structured format for communication with a forum for regular interdisciplinary meetings. We asked nurses to rate the quality of communication and collaboration with hospitalists using a 5‐point ordinal scale. We also assessed teamwork and safety climate using a validated instrument. Multivariable regression analyses were used to assess the impact on length of stay (LOS) and cost using both a concurrent and historic control.RESULTS:A total of 49 of 58 (84%) nurses 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 also rated the teamwork and safety climate significantly higher on the intervention unit (P = 0.008 and P = 0.03 for teamwork and safety climate, respectively). Multivariable 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 no impact on LOS and cost. Further study is required to assess the impact of SIDR on patient safety measures. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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“…25 Several multidisciplinary initiatives are in place on this unit that are associated with increased unit-level collaboration and improved outcomes including integrated patient records, a joint practice committee, joint ICU leadership, and scheduled interdisciplinary meetings and in-service training sessions. 31 This algorithm may require adaption to the needs, resources, clinicians, and culture of a specific ICU. As noted by Gay and colleagues, 21 each ICU has its own "ecosystem," and the environments of different ICU's can be vastly different even within a single institution.…”

Section: Limitationsmentioning

confidence: 99%

Improving Family Satisfaction and Participation in Decision Making in an Intensive Care Unit

Huffines

Johnson

Naranjo

et al. 2013

Critical Care Nurse

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Background Survey data revealed that families of patients in a surgical intensive care unit were not satisfied with their participation in decision making or with how well the multidisciplinary team worked together. Objectives To develop and implement an evidence-based communication algorithm and evaluate its effect in improving satisfaction among patients’ families. Methods A multidisciplinary team developed an algorithm that included bundles of communication interventions at 24, 72, and 96 hours after admission to the unit. The algorithm included clinical triggers, which if present escalated the algorithm. A pre-post design using process improvement methods was used to compare families’ satisfaction scores before and after implementation of the algorithm. Results Satisfaction scores for participation in decision making (45% vs 68%; z = −2.62, P = .009) and how well the health care team worked together (64% vs 83%; z = −2.10, P = .04) improved significantly after implementation. Conclusions Use of an evidence-based structured communication algorithm may be a way to improve satisfaction of families of intensive care patients with their participation in decision making and their perception of how well the unit’s team works together.

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Association between nurse-physician collaboration and patient outcomes in three intensive care units

Abstract: The study offered some support for the importance of physician-nurse collaboration in ICU care delivery, a variable susceptible to intervention and further study.

Cited by 640 publications

References 24 publications

Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

Teamwork Assessment in Internal Medicine: A Systematic Review of Validity Evidence and Outcomes

Improving teamwork: Impact of structured interdisciplinary rounds on a hospitalist unit

Improving Family Satisfaction and Participation in Decision Making in an Intensive Care Unit

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