Background:
A significant barrier to communication between providers on hospital units is the fluidity and geographic dispersion of team members. Geographically localizing physicians to specific units may improve collaboration with other unit‐based team members and create a shared understanding of patients' plan of care.
Methods:
We conducted interviews of a cross‐sectional sample of patients' nurses and physicians in June 2007 and June 2008 before and after an intervention designed to localize physicians to specific units. Prior to localization, physicians cared for patients on as many as 6 different units with no attempt to localize physicians to specific units. Beginning in January 2008, newly admitted patients were first assigned a hospital bed and subsequently a physician team based on the assigned hospital unit. Delocalization was allowed for patient “bounce‐backs” to preserve continuity and for excessive physician volume. We used a survey instrument designed by our research team to characterize nurse–physician communication and assess understanding of patients' plan of care. Two board‐certified internists reviewed nurse and physician responses and rated nurse‐physician agreement on 6 aspects of the plan of care as none, partial, or complete agreement. We calculated a Nurse‐Physician Summary Agreement Score by assigning 0, 1, or 2 points for none, partial, and complete agreement to each of the 6 aspects of the plan of care.
Results:
Prelocalization, 311 of 342 nurses (91%) and 301 of 342 physicians (88%) completed interviews, whereas postlocalization 291 of 294 nurses (99%) and 285 of 294 physicians (97%) completed it. Two hundred and nine of 285 patients (73%) were successfully localized to physicians' designated units in the postlocalization period. After localization, a higher percentage of patients' nurses and physicians were able to correctly identify one another (71% vs. 93%, P < 0.001, and 36% vs. 58%, P < 0.001, for nurses and physicians, respectively). Patients' nurses and physicians reported that communication with one another occurred more often after localization (50% vs. 68%, P < 0.001, and 61% vs. 74%, P < 0.001, for nurses and physicians, respectively). Nurse‐physician agreement was significantly improved after localization for 2 aspects of the plan of care: planned tests and anticipated length of stay. The Nurse‐Physician Summary Agreement Score was higher after localization; however, this result was not statistically significant (7.6 ± 2.3 vs. 8.0 ± 2.2; P = 0.11).
Conclusions:
Hospitalized patients' nurses and physicians were better able to identify one another and reported greater frequency of communication after localizing physicians to specific units. Measures of nurse‐physician agreement on the plan of care showed favorable changes. Attempts to localize medical service physicians to specific hospital units should be combined with other interventions to improve collaboration among team members.
Author Disclosure:
K. J. O'Leary, none; D. B. Wayne, none; M. P. Landler, none; N. Kulkarni, none; C. Haviley, none; K. Hahn, none; J. Jeon, none; K. M. Englert, none; M. V. Williams, none.