Grouping pediatric resident physicians and nurses into unit-based teams is associated with improved frequency and quality of communication, according to a report in the May issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
The need for better dialogue among health care-team members is great, according to the authors. "Physician-nurse communication failures have adverse consequences for patients," they write, citing prior studies that linked such failures to serious medical errors and other problems. One potential way to help reduce these risks "may be to enhance face-to-face communication among caregivers."
Mary Beth Gordon, M.D., from Children's Hospital Boston, and colleagues reorganized some pediatric ward staffing at a tertiary care children's hospital. Prior to the intervention, daily rounds were usually held away from medical units and were not always attended by nursing staff, owing to their immediate duties. The researchers selected two inpatient units, each taking some specialty cases exclusively as well as general cases, and reorganized resident-physician care teams to be limited to patients admitted to their unit. Rounds occurred within the unit, better enabling nurses to take part.
Researchers surveyed resident physicians and nurses at nine intervals, including before the intervention, five to nine months afterward, and 10 through 12 months afterward. Participants were asked whether they knew other staff caring for medically complex patients, how they communicated, the duration of communication, and how well they felt other staff addressed their concerns. Another source of data for the study was residents' paging records for each 24-hour period. In all, 60 residents and 154 nurses participated.
After the care teams were instituted, residents were more likely to identify a patient's primary nurse (62 percent before vs. 82 percent after), were more likely to communicate with the nurse face-to-face, and were more likely to report that the nurse addressed their concerns promptly (44 percent before vs. 82 percent after). These trends persisted for nurses, although at the study's conclusion, half of the nurses surveyed reported that resident physicians were not responding quickly to their concerns. Nevertheless, the number of residents' pages decreased from an average of 19 per day before the intervention to 11 per day at the study's conclusion.
Although there is room for improvement, particularly in nurses' perception of residents' responses, the authors consider this intervention to be beneficial. "Physicians in our study reported increased timeliness of response and the perception that patient care concerns were better met in a unit-based system that provided more opportunity for face-to-face contacts," they write. "The shift to in-person physician-nurse interactions apparently led to a reduction in paging and improved communication quality, which may have great potential to improve patient outcomes."
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