Team treatment. Does a specialized unit improve team performance?

The treatment of inpatients in a contiguous hospital area designated the Arthritis Rehabilitation Unit (ARU) as opposed to the treatment of patients on units discretely spaced throughout the hospital was studied by means of independent retrospective audit of randomly chosen charts with the primary diagnosis of rheumatoid arthritis. Three time periods were considered: T-1 (2 months to 0 months prior to the beginning of the ARU), T-2 (0 months to 5 months of operation of the ARU), T-3 (after 18 to 24 months of operation of the ARU). At T-1 only seven charts were reviewed; ten charts were reviewed at T-2 and T-3. The frequency of fulfillment to audit criteria was calculated as the arithmetic mean. No weighting or preference was given to any of the items. P values were calculated utilizing the Mann-Whitney U test for nonparametric measures. The criteria by which the charts were reviewed were developed through the Delphi method of opinion convergence. Criteria were generated using the principle of optimal medical care. The categories included initial evaluation, treatment plan, outcomes and discharge plan. T-1 compared to T-3 yielded results in overall percentage of effectiveness of: physician, 81 v 90 (NS): nurse, 42 v 60 (P 0.043); occupational therapy, 62 v 58 (NS); physical therapy, 69 v 78 (NS); and social worker, 17 v 88 (P less than 0.001) Geographic isolation of arthritis rehabilitation patients improved measured aspects of their care but not uniformly throughout the rehabilitation team.