Journal article
Relationships within inpatient physician housestaff teams and their association with hospitalized patient outcomes
Journal of hospital medicine, Vol.9(12), pp.764-771
12/2014
DOI: 10.1002/jhm.2274
PMID: 25355652
Abstract
IMPORTANCE
Improving inpatient care delivery has historically focused on improving individual components of the system. Applying the complexity science framework to clinical systems highlights the important role of relationships among providers in influencing system function and clinical outcomes.
OBJECTIVE
To understand whether inpatient medical physician teams can be differentiated based on the relationships among team members, and whether these relationships are associated with patient outcomes, including length of stay (LOS), unnecessary length of stay (ULOS), and complication rates.
DESIGN
Eleven inpatient medicine teams were observed daily during attending rounds for 2‐ to 4‐week periods from September 2008 through June 2011. Detailed field notes were taken regarding patient care activities, team behaviors, and patient characteristics and outcomes. Behaviors were categorized using the Lanham relationship framework, giving each team a relationship score. We used factor analysis to assess the pattern of relationship characteristics and assessed the association between relationship characteristics and patient outcomes.
SETTING
Observations occurred at the Audie L. Murphy Veterans Affairs Hospital and University Hospital in San Antonio, Texas.
PARTICIPANTS
Physicians were chosen based on rotation schedules, experience, and time of year. Patients were included based on their admission to the inpatient medicine teams that were being observed.
MAIN MEASURES
Relationship scores were based on the presence or absence of 7 relationship characteristics. LOS, ULOS, and complication rates were assessed based on team discussions and chart review. The association between relationships and outcomes was assessed using the Kruskal‐Wallis rank sum test.
RESULTS
We observed 11 teams over 352.9 hours, observing 1941 discussions of 576 individual patients. Teams exhibited a range of 0 to 7 relationship characteristics. Relationship scores were significantly associated with complication rates, and presence of trust and mindfulness among teams was significantly associated with ULOS and complication rates.
CONCLUSIONS
Our findings are an important step in understanding the impact of relationships on the outcomes of hospitalized medical patients. This understanding could expand the scope of interventions to improve hospital care to include not only process improvement but also relationships among providers. Journal of Hospital Medicine 2014;9:764–771. © 2014 Society of Hospital Medicine
Details
- Title: Subtitle
- Relationships within inpatient physician housestaff teams and their association with hospitalized patient outcomes
- Creators
- Caitlin McAllister - University of Texas Health Science Center at San AntonioLuci K Leykum - University of Texas Health Science Center at San AntonioHolly Lanham - University of Texas at AustinHeather Schacht Reisinger - University of IowaJamie L Kohn - University of North Carolina at Chapel HillRay Palmer - University of Texas Health Science Center at San AntonioCarla Pezzia - University of Texas Health Science Center at San AntonioMichael Agar - Ethknoworks LLCMichael Parchman - Group Health Research InstituteJacqueline Pugh - University of Texas Health Science Center at San AntonioReuben R McDaniel - University of Texas at Austin
- Resource Type
- Journal article
- Publication Details
- Journal of hospital medicine, Vol.9(12), pp.764-771
- DOI
- 10.1002/jhm.2274
- PMID
- 25355652
- ISSN
- 1553-5592
- eISSN
- 1553-5606
- Number of pages
- 8
- Grant note
- DOI: 10.13039/100000738, name: U.S. Department of Veterans Affairs, award: CDA 07-022
- Language
- English
- Date published
- 12/2014
- Academic Unit
- Center for Social Science Innovation; Internal Medicine
- Record Identifier
- 9984094507802771
Metrics
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