Summary and Comment
Geographic localization of physician teams improves elements of physician–nurse communication.
Assigning patients indiscriminately throughout the hospital creates a barrier to longitudinal working relations between physicians, unit-based nurses, and other staff. This tradition of nongeographic patient assignments can also impede timely communication and coordination of care.
In a single-center study in Chicago, investigators examined the effect of geographic localization on physician–nurse communications and on congruence of daily care plans. Clinician interviews were conducted before and after an intervention that localized physician teams to specific units. Each day, physicians and nurses were interviewed separately about six elements of the care plan for each patient: primary diagnosis, planned tests, planned procedures, changes in medication, anticipated specialty consultations, and expected length of stay. Additionally, nurses were asked to identify the primary responsible physician (intern on teaching services or hospitalist on nonteaching services), whereas physicians were asked to identify patients’ assigned nurses. Nurse-physician agreement on each care-plan component was coded as none, partial, or complete.
Researchers conducted approximately 300 interviews before and 300 after the geographic localization intervention. After localization, nurses were significantly better able to identify responsible physicians (71% vs. 93%), and physicians were better able to identify patients’ nurses by name (36% vs. 58%). Face-to-face communication increased significantly as reported both by physicians (65% to 85%) and by nurses (69% to 84%). Nurse-physician agreement on patient care plans improved significantly only on planned tests and expected length of stay.
Comment: Keeping physician teams localized to specific units has a limited but noticeable effect on enhancing communication and coordinating inpatient goals. Quality, not just frequency, of communication among healthcare providers also must improve to support the interdisciplinary nature of patient care. Restructuring the timing of work rounds to involve other health professionals or holding interdisciplinary rounds also might allow teams to operate more effectively, based on a shared understanding of patient care.
— Grace C. Huang, MD
Published in Journal Watch Hospital Medicine December 21, 2009
Citation(s):
O’Leary KJ et al. Impact of localizing physicians to hospital units on nurse–physician communication and agreement on the plan of care. J Gen Intern Med 2009 Nov; 24:1223.
