From the 2018 HVPAA National Conference
Tony Kurian (Loyola University Medical Center), Roseanne Raphael (Loyola University Medical Center), Sameer Qazi (Loyola University Medical Center)
Loyola University Medical Center is implementing geographic localization of patient care teams throughout the hospital system. These changes may positively affect nurse and physician perceptions of collaborative behaviors.
The purpose of the present study is to evaluate and compare the perception of collaboration between resident physicians and nurses as well as patient experience data in an academic center before and after implementation of geographic localization of patient care teams.
At Loyola University Medical Center, nurse and physician survey tools were developed using validated questionnaires to evaluate nurse and physician attitudes towards collaboration and communication on the general medicine floors. Surveys were distributed among nursing staff and internal medicine housestaff at the end of consecutive general medicine rotations before and after implementation of geographic localization of patient care teams. Patient experience questionnaire data before and after implementation were collected and compared. Data was compared by two sample t-test and Mann-Whitney test for continuous variables and chi square and Fisher exact test for categorical variables as appropriate using MedCalc and Minitab statistical software. Data are presented as median unless otherwise indicated.
Survey data was collected from 23 residents, 37 nurses, and 196 patients prior to implementation and 27 residents, 37 nurses, and 843 patients after implementation of localization over a period of 22 months both before and after implementation of geographic localization. Comparison of data both before and after implementation noted changes in perception of communication and collaboration amongst both nurses and doctors. Analysis of the data shows that nurses felt as though there was better and more open communication of patient plans and communication in general post-localization (p = 0.0023 and p = 0.0344 respectively). Both nurses and physicians agreed that after localization information was better relayed (p = 0.023). It should be noted that nurses and physicians had differing perceptions as to whether they functioned as a team; with physicians believing that nurses and physicians work well as a team post-localization whereas nurses post-localization were not in agreement as to the level at which they did function as a team with physicians (p = 0.005). Patients’ global rating of the hospital was 9-10 on a 10 point scale. Seventy-six percent and 75% of patient’s felt nurses and physicians “always” listen carefully to them, respectively. There was no significant difference in patients’ global hospital rating or perception of communication with nursing and physician staff before and after implementation of geographic localization (p = 0.96, 0.73, and 0.49, respectively).
Our data suggests that resident physician and nurse perceptions on interdisciplinary collaboration and communication is generally improved after implementation of geographic co-localization of patient care teams on inpatient general medicine wards. Patient data suggests favorable hospital rating and perception of communication with nurses and physicians. The study demonstrates that implementation of geographic localization of patient care teams has achieved the goal of improved interdisciplinary collaboration and communication at our institution.
Implications for the Patient
The study demonstrates that implementation of geographic localization of patient care teams has achieved the goal of improved interdisciplinary collaboration and communication at our institution.