Related Experiment Video
Updated: Jul 12, 2025
Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Effect of Complementary Interventions to Redesign Care on Teamwork and Quality for Hospitalized Medical Patients : A
Kevin J O'Leary1, Julie K Johnson2, Mark V Williams3
1Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (K.J.O., G.R.S., J.S.K.).
Background:
Multiple challenges impede interprofessional teamwork and the provision of high-quality care to hospitalized patients.
Objective:
To evaluate the effect of interventions to redesign hospital care delivery on teamwork and patient outcomes.
Design:
Pragmatic controlled trial. Hospitals selected 1 unit for implementation of interventions and a second to serve as a control. (ClinicalTrials.gov: NCT03745677).
Setting:
Medical units at 4 U.S. hospitals.
Participants:
Health care professionals and hospitalized medical patients.
Intervention:
Mentored implementation of unit-based physician teams, unit nurse-physician coleadership, enhanced interprofessional rounds, unit-level performance reports, and patient engagement activities.
Measurements:
Primary outcomes were teamwork climate among health care professionals and adverse events experienced by patients. Secondary outcomes were length of stay (LOS), 30-day readmissions, and patient experience. Difference-in-differences (DID) analyses of patient outcomes compared intervention versus control units before and after implementation of interventions.
Results:
Among 155 professionals who completed pre- and postintervention surveys, the median teamwork climate score was higher after than before the intervention only for nurses (n = 77) (median score, 88.0 [IQR, 77.0 to 91.0] vs. 80.0 [IQR, 70.0 to 89.0]; P = 0.022). Among 3773 patients, a greater percentage had at least 1 adverse event after compared with before the intervention on control units (change, 1.61 percentage points [95% CI, 0.01 to 3.22 percentage points]). A similar percentage of patients had at least 1 adverse event after compared with before the intervention on intervention units (change, 0.43 percentage point [CI, -1.25 to 2.12 percentage points]). A DID analysis of adverse events did not show a significant difference in change (adjusted DID, -0.92 percentage point [CI, -2.49 to 0.64 percentage point]; P = 0.25). Similarly, there were no differences in LOS, readmissions, or patient experience.
Limitation:
Adverse events occurred less frequently than anticipated, limiting statistical power.
Conclusion:
Despite improved teamwork climate among nurses, interventions to redesign care for hospitalized patients were not associated with improved patient outcomes.
Primary Funding Source:
Agency for Healthcare Research and Quality.
Related Concept Videos
01:18Interdisciplinary Care: The Health Care Team-II
Physical Therapist
A physical therapist (PT) aims to restore function or prevent additional impairment in a patient following an injury or disease. Massage, heat, cold, water, sonar waves, exercises, and electrical stimulation are some treatments used by PTs to treat...
01:21Interdisciplinary Care: The Health Care Team-I
Physicians
The physician's primary responsibility is to diagnose illness and direct the medical or surgical treatment of the condition. The authority to admit patients to a healthcare agency or institution and practice care within that setting is granted to physicians by the healthcare agency or institution...
01:13Patient-centered Care
01:03Nursing Interventions I: Taxonomy of Nursing Interventions
A nursing intervention is a treatment or action based on scientific concepts and knowledge from the nursing, behavioral, and physical sciences. Identifying and prioritizing nursing interventions based on the desired outcome...
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:28Acute Coronary Syndrome IV: Interprofessional Care