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Familiarity among residents and nurses improves some aspects of team performance over time
Clinical Question
Does familiarity among residents and nurses increase team performance?
Bottom line
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. 1b-
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Foundation
Setting: Inpatient (ward only)
Synopsis
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.
Reviewer
Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL
Comments
Impact assessment
Very good
Familiarity among residents and nurses improves some aspects
Interesting novel study. Results seem quite intuitive but great to see this kind of evidence. Important that the study intervention was simply "time" spent by PGY1 on a "typical" clinical ward under "normal" operating conditions. Cant' see why this would not apply "universally" in health care settings. I would have been really impressed had there been a positive impact on patient outcome parameters. Would have liked to have seen some kind of patient satisfaction score reported so the study was had patient centric metric included.
Familiarity among residents and nurses improves some aspects
there is evidence that collaberation , communication and professionalism enhancements can improve patient outcomes and reduce medical error. I see this study as a potential tool to support a team based approach to care delvery models