Background: Nurse-physician teamwork is a critical determinant of outcomes among hospitalized patients. Although improvement interventions have been designed for specific settings (eg, intensive care units and operating rooms), less attention has been given to nurse-physician teamwork in hospital medicine. Therefore, our goal was to assess the quality and effectiveness of interventions for improving nurse-physician teamwork in hospital medicine.
Methods: To meet this goal, we conducted a systematic review of the literature from the years 2000 to 2016 with the following databases: MEDLINE, Ovid EMBASE, Ovid PsychINFO, EBSCO CINAHL, EBSCO MegaFILE, and ERIC. We included all experimental study designs that described a quantitative assessment of nurse-physician teamwork in hospital medicine. Our search yielded 2,561 abstracts and 249 full-text articles, which were reviewed independently by 2 investigators; 12 studies were selected for final inclusion. Data extraction included study setting, population and design, intervention, assessment method, and teamwork and patient outcomes.
Results: Of the 12 studies, 10 were conducted in the United States. The studies included a median of 79 nurses and a median of 46 physicians. Most studies (10; 83.3%) did not include an independent control group and instead used either a single-group pretest-posttest design (8; 66.7%) or a single-group posttest only (3; 25%). The majority of studies (7; 58.3%) developed a new instrument to measure teamwork between nurses and physicians. The Communication, Collaboration and Critical Thinking tool was the most frequently used assessment instrument and was the only instrument used in more than 1 of the included studies. In almost all studies (11; 91.7%), the interventions were designed to affect local teamwork processes and relationships. However, only three interventions (25%) were designed to alter the broader organizational or contextual environment in which the teams function. Although most studies (7, 58.3%) showed improvement in teamwork outcomes assessed by nurses, fewer studies showed improved teamwork scores by physicians (1, 8.3%). While four studies reported patient outcomes, only one study showed statistical improvement in this area. Most studies had a medium-to-high risk of bias and used teamwork assessment methods with limited validity evidence.
Conclusions: While interventions can succeed in improving teamwork perceptions among nurses, the effect on physicians’ perceptions and patient outcomes is less clear. Future experiments should ensure the use of a valid teamwork assessment instrument and rigorous study design. Additionally, research is needed to develop and evaluate interventions at the organizational and contextual level, which may have a broader impact on nurse-physician teamwork.