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Original Investigation | Health Care Reform

Structured Interdisciplinary Rounds in a Medical Teaching Unit:  Improving Patient Safety FREE

Kevin J. O’Leary, MD, MS; Ryan Buck, MD; Helene M. Fligiel, MD; Corinne Haviley, RN, MS; Maureen E. Slade, MS, RN, CS; Matthew P. Landler, MD; Nita Kulkarni, MD; Keiki Hinami, MD, MS; Jungwha Lee, PhD, MPH; Samuel E. Cohen, MD; Mark V. Williams, MD; Diane B. Wayne, MD
[+] Author Affiliations

Author Affiliations: Division of Hospital Medicine (Drs O’Leary, Landler, Kulkarni, Hinami, Cohen, and Williams) and Departments of Medicine (Drs Buck, Fligiel, and Wayne) and Preventive Medicine (Dr Lee), Northwestern University Feinberg School of Medicine, and Department of Medicine Nursing, Northwestern Memorial Hospital (Mss Haviley and Slade), Chicago, Illinois. Ms Haviley is now with the Department of Nursing, Central DuPage Hospital, Winfield, Illinois. Dr Cohen is now a resident in the Department of Medicine, Einstein Montefiore Medical Center, New York, New York.


Arch Intern Med. 2011;171(7):678-684. doi:10.1001/archinternmed.2011.128.
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Published online

Background  Effective collaboration and teamwork is essential to providing safe hospital care. The objective of this study was to assess the effect of an intervention designed to improve interdisciplinary collaboration and lower the rate of adverse events (AEs).

Methods  The study was a controlled trial of an intervention, Structured Inter-Disciplinary Rounds, implemented in 1 of 2 similar medical teaching units in a tertiary care academic hospital. The intervention combined a structured format for communication with a forum for regular interdisciplinary meetings. We conducted a retrospective medical record review evaluating 370 randomly selected patients admitted to the intervention and control units (n = 185 each) in the 24 weeks after and 185 admitted to the intervention unit in the 24 weeks before the implementation of Structured Inter-Disciplinary Rounds (N = 555). Medical records were screened for AEs. Two hospitalists confirmed the presence of AEs and assessed their preventability and severity in a masked fashion. We used multivariable Poisson regression models to compare the adjusted incidence of AEs in the intervention unit to that in concurrent and historic control units.

Results  The rate of AEs was 3.9 per 100 patient-days for the intervention unit compared with 7.2 and 7.7 per 100 patient-days, respectively, for the concurrent and historic control units (adjusted rate ratio, 0.54; P = .005; and 0.51; P = .001). The rate of preventable AEs was 0.9 per 100 patient-days for the intervention unit compared with 2.8 and 2.1 per 100 patient-days for the concurrent and historic control units (adjusted rate ratio, 0.27; P = .002; and 0.37; P = .02). The low number of AEs rated as serious or life-threatening precluded statistical analysis for differences in rates of events classified as serious or serious and preventable.

Conclusion  Structured Inter-Disciplinary Rounds significantly reduced the adjusted rate of AEs in a medical teaching unit.

In its seminal report, Crossing the Quality Chasm: A New Health System for the Twenty-first Century, the Institute of Medicine characterized the current provision of health care as “more to know, more to manage, more to watch, more to do, and more people involved in doing it than at any time in the nation's history.”1(p.25) The description by the Institute of Medicine is particularly applicable to the acute care hospital setting, in which many patients experience adverse events (AEs).2,3 Although many AEs are not preventable, a large portion of those that are preventable are attributed to communication failures.46

Communication practices79 and interventions designed to improve teamwork have been studied in many clinical settings.1014 However, little research has focused on improving teamwork at the most common site of hospital care—medical-surgical units. Several important and unique barriers to effective communication among health care professionals exist in these units: teams are large and formed in an ad hoc fashion and team membership is dynamic and dispersed. Physicians, nurses, pharmacists, and other team members typically care for multiple patients simultaneously and work in shifts or rotations, resulting in team membership variability (few patients have identical team membership) and instability (each team has members joining and departing). Research has shown that nurses and physicians in patient care units do not communicate consistently and they frequently are not in agreement regarding their patients' plans of care.15,16 Furthermore, although physicians give high ratings to the quality of their collaboration with nurses, nurses consistently rate the quality of collaboration with hospital physicians relatively poorly.8,9,17

Interdisciplinary rounds (also known as multidisciplinary rounds) have been used as a means to assemble team members in patient care units and improve collaboration regarding the plan of care.1820 Two recent articles reported on the use of Structured Inter-Disciplinary Rounds (SIDR), an intervention that combines a structured format for communication and a forum for daily interdisciplinary meetings.21,22 The intervention was well received by health care professionals and resulted in improved ratings of collaboration and teamwork from nurses. The goal of this study was to assess the effect of the intervention on the rate of AEs in a medical teaching unit.

SETTING AND STUDY DESIGN

The study was conducted at Northwestern Memorial Hospital, an 897-bed tertiary care teaching hospital in Chicago, Illinois, and was approved by the Institutional Review Board of Northwestern University. The study was a controlled trial of an intervention, SIDR, regarding the rate of AEs in general medicine patient care units. One of 2 similar teaching service units was randomly selected for the intervention and the other served as a concurrent control unit. General medical patients were admitted to the study units by Northwestern Memorial Hospital bed assignment personnel in a quasirandomized fashion subject to unit bed availability. No other criteria (eg, diagnosis, severity of illness, or source of patient admission) were used in patient assignment.

Each medical teaching unit consisted of 30 beds and was equipped with continuous cardiac telemetry monitoring. Each unit was staffed by teaching-service physician teams consisting of 1 attending, 1 resident, 1 to 2 interns, and 1 to 2 third-year medical students. Attending physicians rotated into the study units in 2-week blocks and house staff rotated in 4-week blocks. The schedule and makeup of physician teams was created by the chief medical resident with no effort made to place certain physicians in specific study units. As a result of a prior intervention, teaching-service physician teams were localized to specific units in an effort to improve communication practices among nurses and physicians.23 Both units had physician localization and similar structure and staffing of nonphysician health care professionals. Unidirectional alphanumeric paging was available to physicians and nurses on both study units, and all professionals used a fully integrated electronic medical record and computerized physician order entry system (PowerChart Millennium; Cerner Corporation, North Kansas City, Missouri).

INTERVENTION

Structured Inter-Disciplinary Rounds combined a structured format for communication and a forum for regular interdisciplinary meetings. A working group consisting of nurses, resident physicians, pharmacists, and the unit social worker and case manager met every other week during the 3 months before implementation to determine the optimal timing, frequency, format, and location for SIDR. Also, the working group finalized the content of a structured communication tool used during SIDR for newly admitted patients (eAppendix). This tool was modeled after prior research demonstrating the benefit of daily goals-of-care forms11,13 and ensured that important elements of the plan of care were discussed. Based on the working group's recommendation, SIDR took place each weekday at 11 AM in the unit nursing report room and lasted 30 to 40 minutes. The nurse manager and a unit medical director jointly led rounds each day and facilitated closed-loop communication among team members. Structured Inter-Disciplinary Rounds was attended by all nurses and resident physicians caring for patients in the unit, as well as the pharmacist, social worker, and case manager assigned to the unit. The structured communication tool was used in SIDR for all patients newly admitted (ie, in the previous 24 hours) to the unit. The daily plan of care for all other patients was also discussed in SIDR but without the aid of the structured communication tool. This decision was made by the working group in an effort to balance effective communication among professionals with work efficiency. The SIDR program was implemented on July 28, 2008.

AE REVIEW

We conducted a medical record abstraction of 370 randomly selected patients admitted to the intervention and control teaching service units (185 each) from July 28, 2008, through January 11, 2009. In addition, we abstracted medical records for 185 randomly selected patients hospitalized in the intervention unit from January 8, 2008, through June 22, 2008, a period that occurred after localization of physicians to specific patient care units but before the start of the new intern class and the implementation of SIDR. Two internal medicine physicians (R.B. and H.M.F.) identified potential AEs using screening criteria adapted from prior research (eTable 1)3,24,25 and created a narrative summary for each potential AE identified. The physicians performing medical record abstractions received specific training for this study, including an overview of the study, definitions of terms, practice with data collection tools, and discussion of examples of AEs. We defined an AE as an injury due to medical management rather than the natural history of the illness.

Narrative summaries of potential AEs were reviewed in a masked fashion by 2 internal medicine physician-researchers (M.P.L. and N.K.) to determine the presence and preventability of AEs. Physician reviewers used a 6-point confidence scale similar to that used in prior research studies3,2527 to rate the presence of AEs: 1 indicated no evidence that outcome was due to treatment; 2, little evidence that outcome was due to treatment; 3, outcome was possibly due to treatment but was more likely due to disease; 4, outcome was more likely due to treatment than to disease; 5, outcome was probably due to treatment; and 6, outcome was definitely due to treatment. We used a similar 6-point confidence scale to assess the preventability of AEs: 1 indicated virtually no evidence of preventability; 2, slight to modest evidence of preventability; 3, preventability not quite likely; 4, preventability more likely than not; 5, strong evidence of preventability; and 6, virtually certain evidence of preventability.3,2527 We required a confidence score of 4 or greater for determination of the presence and preventability of an AE. Physician reviewers also classified AEs according to 4 levels of severity (life threatening, serious, clinically significant, or trivial).28 An example of a life-threatening event is a nosocomial urinary tract infection that leads to septic shock. Serious events include those that lead to interventions or prolonged hospitalizations (for example, a pressure ulcer or a wound infection that requires debridement). Clinically significant events are more transient (for example, an adverse drug event causing transient abnormalities in laboratory test results). Trivial or insignificant events include minor injuries, such as pain at a venipuncture site. Finally, AEs were assigned to 1 of 10 prespecified categories. Both physician reviewers were experienced in medical record review methods to identify AEs and also received specific training for this study, including definitions of terms, practice with data collection tools, and discussion of examples of AEs. After independent review, the physician reviewers discussed any areas of disagreement and developed consensus ratings.

We assessed the performance of the initial stage of our medical record review method by conducting duplicate abstractions and consensus ratings for the presence and preventability of AEs for a randomly selected sample of 28 patients. The interrater reliability for identification of potential AEs was good (κ = 0.73). The interrater reliability was excellent for the presence (κ = 0.78) and preventability (κ = 1) of AEs.

DATA ANALYSIS

Patient data were obtained from administrative databases and complemented the information from the medical record review. Demographic characteristics were compared using χ2 and t tests for categorical and continuous data, respectively. Primary discharge diagnosis International Classification of Diseases–9 codes were grouped into diagnosis clusters using the Clinical Classification Software developed by the Healthcare Cost and Utilization Project (http://www.hcup-us.ahrq.gov/tools_software.jsp). Diagnosis clusters were then analyzed using χ2 tests. We analyzed consensus ratings of AEs using several methods. We used χ2 tests to compare the percentage of patients with 1 or more AE between the concurrent and historic control units. We also performed multivariable Poisson regression analyses to compare the rate of total and preventable AEs using the concurrent and historic control unit data. All models included patient age, sex, and race as covariates and the number of days in the study unit as the exposure variable. We used backward selection techniques for additional variables, including night admission, weekend and holiday admission, contact isolation status, payer, source of admission, case mix, Charlson comorbidity index (medical record–based),29 and diagnosis related group weight (Medicare, 2008 version). Variables were retained in models at a value of less than .1. Because some patients were initially admitted to the intensive care unit before transfer to the study units and owing to a concern that errors contributing to AEs may have occured before transfer, we repeated analyses restricted to patients initially admitted to the study units. The results were similar and therefore are not reported. We also evaluated the effect of clustering of physicians on study units by repeating models with standard errors robust to the clustering of patients within the data for each physician. We used separate models for the attending, resident, and intern physicians and for the team as a whole. Finally, we repeated analyses using attending physician status (hospitalist vs nonhospitalist) as a covariate. Results for these models accounting for differences in physician team makeup were similar and therefore not reported. All analyses were conducted using Stata version 10.1 (StataCorp LP, College Station, Texas).

CHARACTERISTICS OF PATIENTS

With few exceptions, intervention unit patients were similar to those in the concurrent and the historic control units (Table 1). More patients with acute renal failure and fewer patients with “other” diagnoses were admitted to the intervention unit compared with the concurrent control unit. More patients in the intervention unit were directly admitted and fewer were transferred from outside hospitals during the post-SIDR compared with the pre-SIDR period.

Table Graphic Jump LocationTable 1. Characteristics of Patientsa
RATINGS OF AEs

Overall, 30 patients in the intervention unit (16.2%), 46 in the concurrent control unit (24.9%), and 49 historic control patients (26.5%) experienced 1 or more AEs (P = .04 and .02 for comparison of intervention unit with concurrent and historic control units, respectively). Patients in the intervention unit experienced a significantly lower adjusted rate of total and preventable AEs compared with the concurrent and the historic controls (Table 2). Specifically, the rate of AEs was 3.9 per 100 patient-days in the intervention unit compared with 7.2 per 100 patient-days in the control unit and 7.7 per 100 patient-days during the historic control period (incidence rate ratio [IRR], 0.54; P = .005; and 0.51; P = .001, respectively). The rate of preventable AEs was 0.9 per 100 patient-days in the intervention unit compared with 2.8 per 100 patient-days in the control unit and 2.1 per 100 patient-days during the historic control period (IRR, 0.27; P = .002; and 0.37; P = .02, respectively). Selected examples of preventable AEs are summarized in Table 3. The low number of AEs rated as serious or life threatening precluded statistical analysis for differences in rates of events classified as serious or serious and preventable.

Table Graphic Jump LocationTable 2. Effect of SIDR on Adverse Events (AEs) in a Medical Teaching Servicea
Table Graphic Jump LocationTable 3. Examples of Preventable Adverse Events

Categories of AEs are shown in Table 4. Adverse drug events accounted for the largest portion of AEs, followed by manifestation of poor glycemic control. The rate of adverse drug events was 1.6 per 100 patient-days in the intervention unit compared with 3.8 per 100 patient-days in the control unit and 3.5 per 100 patient-days during the historic control period (IRR, 0.42; P = .006; and 0.47; P = .02, respectively). The rate of AEs not categorized as drug related was 2.3 per 100 patient-days in the intervention unit compared with 3.4 per 100 patient-days in the control unit and 4.3 per 100 patient-days during the historic control period (IRR, 0.69; P = .22; and 0.53; P = .02, respectively). The low number of non–drug-related AEs in each category precluded statistical analysis for specific differences in rates between the intervention and the concurrent units or the historic control period.

Table Graphic Jump LocationTable 4. Effect of SIDR on Adverse Events, by Category

We found that patients hospitalized in a medical teaching unit using SIDR experienced a significantly lower rate of AEs compared with concurrent or historic controls. The effect was mainly explained by a reduction in the rate of AEs deemed to be preventable. We found a low number of AEs rated as serious or life-threatening, which precluded statistical analysis for differences in rates of events classified as serious or serious and preventable. Similar to the findings from prior research evaluating hospital AEs in medical patients,3,27 we found that adverse drug events were the leading cause of AEs, accounting for nearly as many events as all other categories combined.

Lemieux-Charles and McGuire30 and Salas et el31 have noted that team size, instability, and geographic dispersion of membership serve as significant barriers to teamwork. Geographic localization of physicians, which had been previously implemented by some members of our research team,23 provided a foundation for the current intervention. Structured Inter-Disciplinary Rounds provided a means for facilitated, interdisciplinary discussion regarding the plan of care. Our intervention incorporated valuable lessons from prior research, including the role of leadership in shaping team culture and norms30 and the need for input from frontline professionals in the design of interdisciplinary rounds.18,20 The intervention also included the use of a structured communication tool intended to prompt discussion regarding essential elements and to create a shared understanding regarding the plan of care. Similar tools, such as daily goals-of-care forms and surgical safety checklists, have been shown to improve team members' understanding of the plan of care11,13 and to improve patient outcomes.14 The current study builds on prior research22 that found that SIDR was well received by hospital professionals and significantly improved nurses' ratings of collaboration and teamwork. Notably, prior analysis found no effect on length and cost of stay but may have been underpowered in this regard.22

Adverse drug events were the most common category of AE in our study and were significantly reduced by the intervention. The reduction in adverse drug events is notable, given the use of a fully integrated electronic medical record and computerized physician order entry system in the study units. Our findings support the benefit of including nurses and clinical pharmacists in medication discussions and are in agreement with prior research32 showing a reduction in the rate of adverse drug events resulting from greater interaction between clinical pharmacists and patients' health care teams. Manifestations of poor glycemic control were the second most common category of AE in our study. Although the number of AEs in this category was lower in the intervention unit, the low number precluded statistical analysis. We hypothesize that extreme derangements in glycemic control may have been averted in the intervention unit because of enhanced communication between nurses and physicians regarding changes in diet, insulin management, and glucose testing.

Our findings are important because poor communication represents a major cause of preventable AEs in hospitals.5,6,25,33,34 Higher ratings of collaboration and teamwork have been associated with more favorable patient outcomes in observational studies.3537 Recently, Kim and colleagues38 reported an association between the use of interdisciplinary rounds and lower mortality among intensive care unit patients. To our knowledge, ours is the first study to report the effect of interdisciplinary rounds on patient safety–related outcomes in a non–intensive care unit setting.

Structured Inter-Disciplinary Rounds appears to be an effective strategy to promote values and practices consistent with teamwork found in high-reliability organizations.39,40 Teams in such organizations are characterized by their ability to work consistently and effectively over time in complex, dynamic environments while enduring high levels of stress.41 On a practical level, SIDR establishes a forum for the exchange of critical clinical information, collaboration regarding the plan of care, and opportunities to detect and correct errors. These collaborative interactions allow for closed-loop communication, performance monitoring, collective orientation, planning, and team self-correction, among techniques found to enhance team performance.3941

Our study has several limitations. First, it reflects the experience of an intervention in a teaching service unit in a single hospital. We used a concurrent and a historic control in an effort to minimize the effect of potential confounders. Our results were consistent in each comparison, but larger studies will be required to test the reproducibility and generalizability of our findings. Second, our evaluation of AEs was limited to the information available from the medical record. Direct observation and/or interview of health care professionals may have provided important additional information regarding errors and AEs. Third, because the electronic medical record used during medical record abstraction included information regarding dates and hospital unit assignment, we were unable to mask medical record abstractors with regard to patient unit or study time period. Physician reviewers of potential AEs were masked to unit and time of care. The lack of masking at the medical record abstraction stage may bias our study toward finding a positive effect of the intervention. We assessed the performance of the initial stage of our medical record review method by conducting duplicate abstractions and ratings for a random sample of patients and found good interrater reliability for screening of potential AEs and excellent interrater reliability for the presence and preventability of AEs. Fourth, patients were not formally randomized to study units, resulting in small differences in patient characteristics between units. We conducted multivariable regression analyses in an effort to control for confounding due to differences in patient characteristics. Finally, the low number of serious AEs in our study precluded our ability to detect a difference in serious or serious and preventable AEs as a result of the intervention.

In summary, SIDR resulted in a lower rate of AEs in a medical teaching unit. Future efforts should assess the effect of SIDR on AEs of serious clinical severity and whether the intervention reduces the rate of AEs when implemented on a broader scale.

Correspondence: Kevin J. O’Leary, MD, MS, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 211 E Ontario St, Seventh Floor, Chicago, IL 60611 (keoleary@nmh.org).

Accepted for Publication: November 9, 2010.

Author Contributions: Drs O’Leary, Hinami, Lee, Williams, and Wayne and Ms Haviley had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: O’Leary, Buck, Haviley, Slade, Williams, and Wayne. Acquisition of data: O’Leary, Buck, Fligiel, Haviley, and Cohen. Analysis and interpretation of data: O’Leary, Buck, Haviley, Landler, Kulkarni, Hinami, Lee, Cohen, and Williams. Drafting of the manuscript: O’Leary, Haviley, Lee, Williams, and Wayne. Critical revision of the manuscript for important intellectual content: Buck, Fligiel, Slade, Landler, Kulkarni, Hinami, Cohen, and Williams. Statistical analysis: O’Leary and Lee. Administrative, technical, and material support: O’Leary, Slade, Landler, Kulkarni, Hinami, Cohen, and Wayne. Study supervision: Williams and Wayne.

Financial Disclosure: Dr Williams reports royalties for Comprehensive Hospital Medicine from Elsevier, honoraria from the Society of Hospital Medicine (as Editor-in-Chief of the Journal of Hospital Medicine), and for presentations at grand rounds and conferences from the University of California, San Francisco, the Kentucky Hospital Association, Lenox Hill Hospital, Mt Sinai Hospital, the Indiana Hospital Association, Aurora Medical Center (Wisconsin), Stony Brook Medical Center, the Medical University of South Carolina, University of Michigan, and Maimonides Medical Center, and grants from the Society of Hospital Medicine to the Northwestern University Feinberg School of Medicine for Project BOOST (Better Outcomes for Older Adults Through Safe Transitions).

Funding/Support: Dr O’Leary received funding support from Northwestern Memorial Hospital.

 Crossing the Quality Chasm: A New Health System for the Twenty-first Century.  Washington, DC Institute of Medicine2001;
Brennan  TALeape  LLLaird  NM  et al.  Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. N Engl J Med 1991;324 (6) 370- 376
PubMed Link to Article
Thomas  EJStuddert  DMBurstin  HR  et al.  Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 2000;38 (3) 261- 271
PubMed Link to Article
Neale  GWoloshynowych  MVincent  C Exploring the causes of adverse events in NHS hospital practice. J R Soc Med 2001;94 (7) 322- 330
PubMed
Wilson  RMRunciman  WBGibberd  RWHarrison  BTNewby  LHamilton  JD The Quality in Australian Health Care Study. Med J Aust 1995;163 (9) 458- 471
PubMed
Sutcliffe  KMLewton  ERosenthal  MM Communication failures: an insidious contributor to medical mishaps. Acad Med 2004;79 (2) 186- 194
PubMed Link to Article
Lingard  LEspin  SWhyte  S  et al.  Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 2004;13 (5) 330- 334
PubMed Link to Article
Makary  MASexton  JBFreischlag  JA  et al.  Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg 2006;202 (5) 746- 752
PubMed Link to Article
Thomas  EJSexton  JBHelmreich  RL Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med 2003;31 (3) 956- 959
PubMed Link to Article
Morey  JCSimon  RJay  GD  et al.  Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 2002;37 (6) 1553- 1581
PubMed Link to Article
Narasimhan  MEisen  LAMahoney  CDAcerra  FLRosen  MJ Improving nurse-physician communication and satisfaction in the intensive care unit with a daily goals worksheet. Am J Crit Care 2006;15 (2) 217- 222
PubMed
Nielsen  PEGoldman  MBMann  S  et al.  Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial. Obstet Gynecol 2007;109 (1) 48- 55
PubMed Link to Article
Pronovost  PBerenholtz  SDorman  TLipsett  PASimmonds  THaraden  C Improving communication in the ICU using daily goals. J Crit Care 2003;18 (2) 71- 75
PubMed Link to Article
Haynes  ABWeiser  TGBerry  WR  et al. Safe Surgery Saves Lives Study Group, A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360 (5) 491- 499
PubMed Link to Article
Evanoff  BPotter  PWolf  LGrayson  DDunagan  CBoxerman  S Can we talk? priorities for patient care differed among health care providers. Henriksen  KBattles  JBMarks  ESLewin  DIAdvances in Patient Safety: From Research to Implementation. 1AHRQ publication 05-0021-1. Rockville, MD Agency for Healthcare Research and Quality February2005;5- 14
O’Leary  KJThompson  JALandler  MP  et al.  Patterns of nurse-physician communication and agreement on the plan of care. Qual Saf Health Care 2010;19 (3) 195- 199
PubMed Link to Article
O’Leary  KJRitter  CDWheeler  HSzekendi  MKBrinton  TSWilliams  MV Teamwork on inpatient medical units: assessing attitudes and barriers. Qual Saf Health Care 2010;19 (2) 117- 121
PubMed Link to Article
O’Mahony  SMazur  ECharney  PWang  YFine  J Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of stay. J Gen Intern Med 2007;22 (8) 1073- 1079
PubMed Link to Article
Vazirani  SHays  RDShapiro  MFCowan  M Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. Am J Crit Care 2005;14 (1) 71- 77
PubMed
Curley  CMcEachern  JESperoff  T A firm trial of interdisciplinary rounds on the inpatient medical wards: an intervention designed using continuous quality improvement. Med Care 1998;36 (8) ((suppl)) AS4- AS12
PubMed Link to Article
O’Leary  KJHaviley  CSlade  MEShah  HMLee  JWilliams  MV Improving teamwork: impact of structured interdisciplinary rounds on teamwork on a hospitalist unit. J Hosp Med 2011;6 (2) 88- 93
PubMed Link to Article
O’Leary  KJWayne  DBHaviley  CSlade  MELee  JWilliams  MV Improving teamwork: impact of structured interdisciplinary rounds on a medical teaching unit. J Gen Intern Med 2010;25 (8) 826- 832
PubMed Link to Article
O’Leary  KJWayne  DBLandler  MP  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;24 (11) 1223- 1227
PubMed Link to Article
Griffin  FAResar  RK IHI Global Trigger Tool for Measuring Adverse Events.  Cambridge, MA Institute for Healthcare Improvement2007;
Leape  LLBrennan  TALaird  N  et al.  The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II. N Engl J Med 1991;324 (6) 377- 384
PubMed Link to Article
Baker  GRNorton  PGFlintoft  V  et al.  The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004;170 (11) 1678- 1686
PubMed Link to Article
Forster  AJAsmis  TRClark  HD  et al. Ottawa Hospital Patient Safety Study, Ottawa Hospital Patient Safety Study: incidence and timing of adverse events in patients admitted to a Canadian teaching hospital. CMAJ 2004;170 (8) 1235- 1240
PubMed Link to Article
Weissman  JSSchneider  ECWeingart  SN  et al.  Comparing patient-reported hospital adverse events with medical record review: do patients know something that hospitals do not? Ann Intern Med 2008;149 (2) 100- 108
PubMed Link to Article
Charlson  MEPompei  PAles  KLMacKenzie  CR A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40 (5) 373- 383
PubMed Link to Article
Lemieux-Charles  LMcGuire  WL What do we know about health care team effectiveness? a review of the literature. Med Care Res Rev 2006;63 (3) 263- 300
PubMed Link to Article
Salas  EDiazGranados  DKlein  C  et al.  Does team training improve team performance? a meta-analysis. Hum Factors 2008;50 (6) 903- 933
PubMed Link to Article
Kaboli  PJHoth  ABMcClimon  BJSchnipper  JL Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med 2006;166 (9) 955- 964
PubMed Link to Article
Donchin  YGopher  DOlin  M  et al.  A look into the nature and causes of human errors in the intensive care unit. Crit Care Med 1995;23 (2) 294- 300
PubMed Link to Article
Joint Commission on Accreditation of Healthcare Organizations, Sentinel event statistics. Joint Commission on Accreditation of Healthcare Organizations Web site. http://www.jointcommission.org/sentinel_event.aspx. Accessed February 20, 2011
Baggs  JGSchmitt  MHMushlin  AI  et al.  Association between nurse-physician collaboration and patient outcomes in three intensive care units. Crit Care Med 1999;27 (9) 1991- 1998
PubMed Link to Article
Davenport  DLHenderson  WGMosca  CLKhuri  SFMentzer  RM  Jr Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions. J Am Coll Surg 2007;205 (6) 778- 784
PubMed Link to Article
Wheelan  SABurchill  CNTilin  F The link between teamwork and patients' outcomes in intensive care units. Am J Crit Care 2003;12 (6) 527- 534
PubMed
Kim  MMBarnato  AEAngus  DCFleisher  LAKahn  JM The effect of multidisciplinary care teams on intensive care unit mortality [published correction appears in Arch Intern Med. 2010;170(10):867]. Arch Intern Med 2010;170 (4) 369- 376
PubMed Link to Article
Baker  DPDay  RSalas  E Teamwork as an essential component of high-reliability organizations. Health Serv Res 2006;41 (4, pt 2) 1576- 1598
PubMed Link to Article
Wilson  KABurke  CSPriest  HASalas  E Promoting health care safety through training high reliability teams. Qual Saf Health Care 2005;14 (4) 303- 309
PubMed Link to Article
Salas  ESims  DEBurke  CS Is there a “big five” in teamwork? Small Group Res 2005;36 (5) 555- 599
Link to Article

Figures

Tables

Table Graphic Jump LocationTable 1. Characteristics of Patientsa
Table Graphic Jump LocationTable 2. Effect of SIDR on Adverse Events (AEs) in a Medical Teaching Servicea
Table Graphic Jump LocationTable 3. Examples of Preventable Adverse Events
Table Graphic Jump LocationTable 4. Effect of SIDR on Adverse Events, by Category

References

 Crossing the Quality Chasm: A New Health System for the Twenty-first Century.  Washington, DC Institute of Medicine2001;
Brennan  TALeape  LLLaird  NM  et al.  Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. N Engl J Med 1991;324 (6) 370- 376
PubMed Link to Article
Thomas  EJStuddert  DMBurstin  HR  et al.  Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 2000;38 (3) 261- 271
PubMed Link to Article
Neale  GWoloshynowych  MVincent  C Exploring the causes of adverse events in NHS hospital practice. J R Soc Med 2001;94 (7) 322- 330
PubMed
Wilson  RMRunciman  WBGibberd  RWHarrison  BTNewby  LHamilton  JD The Quality in Australian Health Care Study. Med J Aust 1995;163 (9) 458- 471
PubMed
Sutcliffe  KMLewton  ERosenthal  MM Communication failures: an insidious contributor to medical mishaps. Acad Med 2004;79 (2) 186- 194
PubMed Link to Article
Lingard  LEspin  SWhyte  S  et al.  Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 2004;13 (5) 330- 334
PubMed Link to Article
Makary  MASexton  JBFreischlag  JA  et al.  Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg 2006;202 (5) 746- 752
PubMed Link to Article
Thomas  EJSexton  JBHelmreich  RL Discrepant attitudes about teamwork among critical care nurses and physicians. Crit Care Med 2003;31 (3) 956- 959
PubMed Link to Article
Morey  JCSimon  RJay  GD  et al.  Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res 2002;37 (6) 1553- 1581
PubMed Link to Article
Narasimhan  MEisen  LAMahoney  CDAcerra  FLRosen  MJ Improving nurse-physician communication and satisfaction in the intensive care unit with a daily goals worksheet. Am J Crit Care 2006;15 (2) 217- 222
PubMed
Nielsen  PEGoldman  MBMann  S  et al.  Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial. Obstet Gynecol 2007;109 (1) 48- 55
PubMed Link to Article
Pronovost  PBerenholtz  SDorman  TLipsett  PASimmonds  THaraden  C Improving communication in the ICU using daily goals. J Crit Care 2003;18 (2) 71- 75
PubMed Link to Article
Haynes  ABWeiser  TGBerry  WR  et al. Safe Surgery Saves Lives Study Group, A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009;360 (5) 491- 499
PubMed Link to Article
Evanoff  BPotter  PWolf  LGrayson  DDunagan  CBoxerman  S Can we talk? priorities for patient care differed among health care providers. Henriksen  KBattles  JBMarks  ESLewin  DIAdvances in Patient Safety: From Research to Implementation. 1AHRQ publication 05-0021-1. Rockville, MD Agency for Healthcare Research and Quality February2005;5- 14
O’Leary  KJThompson  JALandler  MP  et al.  Patterns of nurse-physician communication and agreement on the plan of care. Qual Saf Health Care 2010;19 (3) 195- 199
PubMed Link to Article
O’Leary  KJRitter  CDWheeler  HSzekendi  MKBrinton  TSWilliams  MV Teamwork on inpatient medical units: assessing attitudes and barriers. Qual Saf Health Care 2010;19 (2) 117- 121
PubMed Link to Article
O’Mahony  SMazur  ECharney  PWang  YFine  J Use of multidisciplinary rounds to simultaneously improve quality outcomes, enhance resident education, and shorten length of stay. J Gen Intern Med 2007;22 (8) 1073- 1079
PubMed Link to Article
Vazirani  SHays  RDShapiro  MFCowan  M Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. Am J Crit Care 2005;14 (1) 71- 77
PubMed
Curley  CMcEachern  JESperoff  T A firm trial of interdisciplinary rounds on the inpatient medical wards: an intervention designed using continuous quality improvement. Med Care 1998;36 (8) ((suppl)) AS4- AS12
PubMed Link to Article
O’Leary  KJHaviley  CSlade  MEShah  HMLee  JWilliams  MV Improving teamwork: impact of structured interdisciplinary rounds on teamwork on a hospitalist unit. J Hosp Med 2011;6 (2) 88- 93
PubMed Link to Article
O’Leary  KJWayne  DBHaviley  CSlade  MELee  JWilliams  MV Improving teamwork: impact of structured interdisciplinary rounds on a medical teaching unit. J Gen Intern Med 2010;25 (8) 826- 832
PubMed Link to Article
O’Leary  KJWayne  DBLandler  MP  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;24 (11) 1223- 1227
PubMed Link to Article
Griffin  FAResar  RK IHI Global Trigger Tool for Measuring Adverse Events.  Cambridge, MA Institute for Healthcare Improvement2007;
Leape  LLBrennan  TALaird  N  et al.  The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II. N Engl J Med 1991;324 (6) 377- 384
PubMed Link to Article
Baker  GRNorton  PGFlintoft  V  et al.  The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004;170 (11) 1678- 1686
PubMed Link to Article
Forster  AJAsmis  TRClark  HD  et al. Ottawa Hospital Patient Safety Study, Ottawa Hospital Patient Safety Study: incidence and timing of adverse events in patients admitted to a Canadian teaching hospital. CMAJ 2004;170 (8) 1235- 1240
PubMed Link to Article
Weissman  JSSchneider  ECWeingart  SN  et al.  Comparing patient-reported hospital adverse events with medical record review: do patients know something that hospitals do not? Ann Intern Med 2008;149 (2) 100- 108
PubMed Link to Article
Charlson  MEPompei  PAles  KLMacKenzie  CR A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40 (5) 373- 383
PubMed Link to Article
Lemieux-Charles  LMcGuire  WL What do we know about health care team effectiveness? a review of the literature. Med Care Res Rev 2006;63 (3) 263- 300
PubMed Link to Article
Salas  EDiazGranados  DKlein  C  et al.  Does team training improve team performance? a meta-analysis. Hum Factors 2008;50 (6) 903- 933
PubMed Link to Article
Kaboli  PJHoth  ABMcClimon  BJSchnipper  JL Clinical pharmacists and inpatient medical care: a systematic review. Arch Intern Med 2006;166 (9) 955- 964
PubMed Link to Article
Donchin  YGopher  DOlin  M  et al.  A look into the nature and causes of human errors in the intensive care unit. Crit Care Med 1995;23 (2) 294- 300
PubMed Link to Article
Joint Commission on Accreditation of Healthcare Organizations, Sentinel event statistics. Joint Commission on Accreditation of Healthcare Organizations Web site. http://www.jointcommission.org/sentinel_event.aspx. Accessed February 20, 2011
Baggs  JGSchmitt  MHMushlin  AI  et al.  Association between nurse-physician collaboration and patient outcomes in three intensive care units. Crit Care Med 1999;27 (9) 1991- 1998
PubMed Link to Article
Davenport  DLHenderson  WGMosca  CLKhuri  SFMentzer  RM  Jr Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions. J Am Coll Surg 2007;205 (6) 778- 784
PubMed Link to Article
Wheelan  SABurchill  CNTilin  F The link between teamwork and patients' outcomes in intensive care units. Am J Crit Care 2003;12 (6) 527- 534
PubMed
Kim  MMBarnato  AEAngus  DCFleisher  LAKahn  JM The effect of multidisciplinary care teams on intensive care unit mortality [published correction appears in Arch Intern Med. 2010;170(10):867]. Arch Intern Med 2010;170 (4) 369- 376
PubMed Link to Article
Baker  DPDay  RSalas  E Teamwork as an essential component of high-reliability organizations. Health Serv Res 2006;41 (4, pt 2) 1576- 1598
PubMed Link to Article
Wilson  KABurke  CSPriest  HASalas  E Promoting health care safety through training high reliability teams. Qual Saf Health Care 2005;14 (4) 303- 309
PubMed Link to Article
Salas  ESims  DEBurke  CS Is there a “big five” in teamwork? Small Group Res 2005;36 (5) 555- 599
Link to Article

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Structured Interdisciplinary Rounds in a Medical Teaching Unit: Improving Patient Safety
Arch Intern Med.2011;171(7):678-684.eAppendix

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eAppendix 1. Structured Interdisciplinary Rounds Communication Tool

eTable 1. Screening criteria for potential adverse events
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