Unit-based care teams and the frequency and quality of physician-nurse communications

To determine whether reorganizing physicians into unit-based teams in general pediatric wards is associated with greater ability to identify other care team members, increased face-to-face communication between physicians and nurses, greater perception that their patient care concerns were met, and decreased number of pages to residents.

Prospective intervention study with data collected before and at 2 time points after implementation of unit-based teams.

General pediatric wards at an urban, tertiary care, freestanding children's hospital from April 1, 2008, through June 30, 2009.

Pediatric residents rotating in the medical wards (n = 60) and ward-based pediatric nurses (n = 154).

We reorganized resident-physician care teams to be based on specific inpatient units, with residents admitting and caring only for patients on their assigned unit.

Anonymous physician and nurse self-reports of communication practices and number of pages residents received.

In the unit-based team system, physicians were more likely to be able to identify the nurse for their patients with the most complex conditions (62.3% vs 82.8% vs 82.5%, P = .05), to report contacting (27.3% vs 64.9% vs 56.9%, P = .01) and being contacted by (7.7% vs 48.2% vs 55.2%, P = .002) that nurse in person, and to believe their patient care concerns were met (44.2% vs 82.1% vs 81.8%, P = .009). Nurses reported parallel improvements in communication patterns. The mean number of pages per day to residents decreased by 42.1% (19 vs 10 vs 11, P < .001).

Unit-based teams improve the frequency and quality of multidisciplinary communication, which may create an improved climate for patient safety.