Does familiarity among residents and nurses increase team performance?
This was perhaps a first-of-its-kind study looking at the effect of familiarity among medicine residents and nurses on overall team performance. Some elements of teamwork improved (higher team performance on simulation events, increased nurse inclusion on rounds) in the groups who were familiar with one another over time. However, although nurses’ perceptions regarding a positive teamwork culture were stronger in the familiar group at 6 months, the 2 groups had similar results at 12 months, suggesting that the added experience of residents in the latter half of the year may have improved their relationships with nurses.
Plan de l'etude:
Randomized controlled trial (nonblinded)
Inpatient (ward only)
Internal medicine residents generally rotate on and off different units, working only transiently with a group of nurses on a single unit. In this study at a single academic medical center, investigators assigned 15 randomly selected medicine interns (intervention group) to spend all 4 of their 4-week medicine rotations on the same medical floor. Another 18 interns (control group) were assigned to spend their first medicine rotation on a second medical floor, and their remaining 3 rotations across 5 other floors. The study took place from June 2019 to June 2020, with a pause from March to May 2020 because of a team structure change at the start of the COVID-19 pandemic. The primary outcome was team performance, evaluated by observations of study teams consisting of 2 residents and 2 nurses in 2 medical simulation scenarios, the first simulation (diagnosis and response to anaphylactic event) at 6 months and the second (negotiating medication dose with an angry patient) at 12 months. Additionally, time-motion direct observations of teams were performed to assess interprofessional communication, and surveys were administered to both the residents and nurses to assess psychological safety and teamwork culture. Overall, there was no significant difference in teamwork performance between the 2 study groups at the 6-month simulation, but the intervention group scored higher in leadership and management at the 12-month simulation. In the time-motion analysis, the intervention group was more likely to have a nurse present on work rounds (47% vs 28%; P = .03). For the survey results, the intervention group nurses were more likely to describe a positive teamwork culture as compared with the control group nurses on the 6-month survey, but the difference was no longer significant on the 12-month survey. Further, there were no differences in patient outcomes including length of stay, intensive care unit transfer, mortality, or discharge disposition.
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine