Background: Most academic general medical services cover patients across several different care units in the hospital. Studies have shown that de-regionalized care leads to a lack of team cohesion and poor communication between healthcare providers. Prior studies have shown that teamwork improves patient outcomes and increases health care worker satisfaction. However, little information using validated tools is available about the effects of health care team regionalization on interprofessional teamwork.
Methods: In June, 2013, we regionalized six general medical teams at our 750-bed academic medical center such that physicians, nurses, and other personnel cared for patients on the same unit. We electronically administered the Assessment of Interprofessional Team Collaboration Survey (AITCS) to health care providers on these units, including interns, residents, attendings, nurses, social workers, and care coordinators April through June in the years pre- and post-regionalization. The AITCS is a validated scale to assess team collaboration composed of the following three subscales: 1. coordination, 2. cooperation, and 3. partnership/shared decision-making. The maximum possible AITCS score is 185 with higher scores representing greater team collaboration. Total and subscale results were compared using linear regression adjusted for role, and subgroup analyses of results were conducted for each role.
Results: The response rate was 57% pre-regionalization and 58% post-regionalization. A total of 157 health care providers completed the AITCS pre-regionalization (16 interns, 23 residents, 20 attendings, 89 nurses, and 9 social workers and care coordinators) and 189 post-regionalization (51 interns, 29 residents, 22 attendings, 81 nurses, and 6 social workers and care coordinators). The mean total AITCS score increased from 147 pre-regionalization to 153 post-regionalization (adjusted difference 5.7 (95% CI 1.6 to 9.8), P<0.006). There were significant improvements in the coordination (adjusted difference 1.3 (95% CI 0.4 to 2.2), p=0.006) and partnership (adjusted difference 2.8, (95% CI 0.9 to 4.7), p=0.004) subscales, but not in cooperation (adjusted difference 1.04 (95% CI 0.2 to 2.3), p=0.09) post- versus pre-regionalization. In subgroup analyses, attending physicians were the only group of providers to report a significant increase in teamwork post-regionalization as measured by the total AITCS score [150 vs.162, adjusted difference 11.8, P=0.05]. Residents reported a significant increase in coordination post-regionalization [adjusted difference 3.0, p=0.006].
Conclusions: Regionalization of an academic general medical service increased perceptions of interprofessional collaborative practice. Attending physicians perceived the greatest impact of regionalization on teamwork. Restructuring inpatient health care teams has the potential to foster collaboration.