New RCT – Teamwork Makes the… Hospital Work

Written by Amanda Mathews

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Resident and nurse teams that worked together exclusively performed better on advanced medical simulations, were more likely to have nurses present on patient rounds, and had improved teamwork earlier in the year than rotating resident/nurse teams.

Why does this matter?
Interdisciplinary teamwork is vital to safe and effective care in the ED, yet it can be difficult to build strong teams with rotating resident and nurse schedules. This study determined whether increased familiarity of resident-nurse inpatient medical teams improved outcomes in four categories: team performance, interprofessional communication, psychological safety, and patient-related outcomes.

Teamwork makes the hospital work
This was a randomized clinical trial of PGY-1 residents at a large quaternary care medical center. Fifteen PGY-1 residents spent the entirety of their general medicine inpatient time (12 weeks) on a single inpatient floor, while a control group of 18 PGY-1 residents spent their general medicine inpatient time rotating on four different inpatient floors.

Team performance was evaluated via team simulations at 6 months and 12 months. Each simulation consisted of two PGY-1 residents and a nurse from their cohort. They were evaluated by three clinicians not involved in the study. There was no statistical difference in performance at the 6-month simulation; however, at the 12-month simulation, the intervention group was rated as more likely to work together as a unit (p= 0.03) and communicate as a team (p= 0.02). 

Interprofessional communication was evaluated via time motion observation of daily rounds. Intervention team nurses were more likely to be present on rounds (p=0.03) than control group nurses. Psychological safety was evaluated via survey of the participating residents and nurses. At the 6-month mark, nurses in the intervention group were more likely to rate their relationship with PGY-1 residents on their floor as excellent to outstanding (p=0.03), to report all practitioners came together to overcome hurdles (p=0.01), to believe input of all practitioners was valued (p<0.01), and that feedback between practitioners was positive (p=0.03). These differences were no longer significant at the 12-month survey. There was no statistically significant difference in patient outcomes amongst the two groups.

This study makes a lot of sense…the more familiar residents are with their nursing colleagues, the stronger the team performs! Residents, faculty, and nurses can all work together to keep lines of communication open and encourage cohesion on shift to help build stronger ED teams.

Source
Effect of Increased Interprofessional Familiarity on Team Performance, Communication, and Psychological Safety on Inpatient Medical Teams: A Randomized Clinical Trial. JAMA Intern Med. 2022 Oct 10. doi: 10.1001/jamainternmed.2022.4373. Online ahead of print.

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