PMID- 26917417
OWN - NLM
STAT- MEDLINE
DCOM- 20180108
LR  - 20180924
IS  - 1553-5606 (Electronic)
IS  - 1553-5592 (Linking)
VI  - 11
IP  - 9
DP  - 2016 Sep
TI  - Impact of regionalized care on concordance of plan and preventable adverse events 
      on general medicine services.
PG  - 620-7
LID - 10.1002/jhm.2566 [doi]
AB  - BACKGROUND: Dispersion of inpatient care teams across different medical units 
      impedes effective team communication, potentially leading to adverse events 
      (AEs). OBJECTIVE: To regionalize 3 inpatient general medical teams to nursing 
      units and examine the association with communication and preventable AEs. DESIGN: 
      Pre-post cohort analysis. SETTING: A 700-bed academic medical center. PATIENTS: 
      General medicine patients on any of the participating nursing units before and 
      after implementation of regionalized care. INTERVENTION: Regionalizing 3 general 
      medical physician teams to 3 corresponding nursing units. MEASUREMENTS: 
      Concordance of patient care plan between nurse and intern, and adjusted odds of 
      preventable AEs. RESULTS: Of the 414 included nurse and intern paired surveys, 
      there were no significant differences pre- versus postregionalization in total 
      mean concordance scores (0.65 vs 0.67, P = 0.26), but there was significant 
      improvement in agreement on expected discharge date (0.56 vs 0.68, P = 0.003), 
      knowledge of the other provider's name (0.56 vs 0.86,P < 0.001), and daily care 
      plan discussions (0.73 vs 0.88, P < 0.001). Of the 392 reviewed patient medical 
      records, there was no significant difference in the adjusted odds of preventable 
      AEs pre- versus postregionalization (adjusted odds ratio: 1.37, 95% confidence 
      interval: 0.69, 2.69). CONCLUSIONS: We found that regionalization of care teams 
      improved recognition of care team members, discussion of daily care plan, and 
      agreement on estimated discharge date, but did not significantly improve nurse 
      and physician concordance of the care plan or reduce the odds of preventable AEs. 
      Our findings suggest that regionalization alone may be insufficient to 
      effectively promote communication and lead to patient safety improvements. 
      Journal of Hospital Medicine 2016;11:620-627. (c) 2016 Society of Hospital 
      Medicine.
CI  - (c) 2016 Society of Hospital Medicine.
FAU - Mueller, Stephanie K
AU  - Mueller SK
AD  - Brigham and Women's Hospital Hospitalist Service and Division of General Internal 
      Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 
      smueller1@partners.org.
AD  - Department of Medicine, Harvard Medical School, Boston, Massachusetts. 
      smueller1@partners.org.
FAU - Schnipper, Jeffrey L
AU  - Schnipper JL
AD  - Brigham and Women's Hospital Hospitalist Service and Division of General Internal 
      Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
AD  - Department of Medicine, Harvard Medical School, Boston, Massachusetts.
FAU - Giannelli, Kyla
AU  - Giannelli K
AD  - Brigham and Women's Hospital Hospitalist Service and Division of General Internal 
      Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
FAU - Roy, Christopher L
AU  - Roy CL
AD  - Brigham and Women's Hospital Hospitalist Service and Division of General Internal 
      Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
AD  - Department of Medicine, Harvard Medical School, Boston, Massachusetts.
FAU - Boxer, Robert
AU  - Boxer R
AD  - Brigham and Women's Hospital Hospitalist Service and Division of General Internal 
      Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
AD  - Department of Medicine, Harvard Medical School, Boston, Massachusetts.
LA  - eng
GR  - K08 HS023331/HS/AHRQ HHS/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20160224
PL  - United States
TA  - J Hosp Med
JT  - Journal of hospital medicine
JID - 101271025
SB  - IM
MH  - Academic Medical Centers
MH  - Cohort Studies
MH  - *Communication
MH  - Female
MH  - *Hospital Medicine
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - *Patient Care Planning
MH  - *Patient Safety
MH  - Physician-Nurse Relations
EDAT- 2016/02/27 06:00
MHDA- 2018/01/09 06:00
CRDT- 2016/02/27 06:00
PHST- 2015/09/28 00:00 [received]
PHST- 2016/01/14 00:00 [revised]
PHST- 2016/01/28 00:00 [accepted]
PHST- 2016/02/27 06:00 [entrez]
PHST- 2016/02/27 06:00 [pubmed]
PHST- 2018/01/09 06:00 [medline]
AID - 10.1002/jhm.2566 [doi]
PST - ppublish
SO  - J Hosp Med. 2016 Sep;11(9):620-7. doi: 10.1002/jhm.2566. Epub 2016 Feb 24.