Dataset Information

Impact of localizing physicians to hospital units on nurse-physician communication and agreement on the plan of care.

ABSTRACT:

Background

A significant barrier to communication among patient care providers in hospitals is the geographic dispersion of team members.

Objective

To determine whether localizing physicians to specific patient care units improves nurse-physician communication and agreement on patients' plans of care.

Methods

We conducted structured interviews of a cross-sectional sample of nurses and physicians before and after an intervention to localize physicians to specific patient care units. Interviews characterized patterns of nurse-physician communication and assessed understanding of patients' plans of care. Two internists reviewed responses and rated nurse-physician agreement on six aspects of the plan of care as none, partial, or complete agreement.

Results

Three hundred eleven of 342 (91%) and 291 of 294 (99%) patients' nurses and 301 of 342 (88%) and 285 of 294 (97%) physicians completed the interview during the pre- and post-localization periods. Two hundred nine of 285 (73%) patients were localized to physicians' designated patient care units in the post-localization period. After localization, a higher percentage of patients' nurses and physicians was able to correctly identify one another (93% vs. 71%; p < 0.001 and 58% vs. 36%; p < 0.001, respectively). Nurses and physicians reported more frequent communication after localization (68% vs. 50%; p < 0.001 and 74% vs. 61%; p < 0.001, respectively). Nurse-physician agreement was significantly improved for two aspects of the plan of care: planned tests and anticipated length of stay.

Conclusions

Although nurses and physicians were able to identify one another and communicated more frequently after localizing physicians to specific patient care units, there was little impact on nurse-physician agreement on the plan of care.

SUBMITTER: O'Leary KJ

PROVIDER: S-EPMC2771243 | biostudies-literature | 2009 Nov

REPOSITORIES: biostudies-literature

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Publications

Impact of localizing physicians to hospital units on nurse-physician communication and agreement on the plan of care.

O'Leary Kevin J KJ Wayne Diane B DB Landler Matthew P MP Kulkarni Nita N Haviley Corinne C Hahn Katherine J KJ Jeon Jiyeon J Englert Katherine M KM Williams Mark V MV

Journal of general internal medicine 20090919 11

<h4>Background</h4>A significant barrier to communication among patient care providers in hospitals is the geographic dispersion of team members.<h4>Objective</h4>To determine whether localizing physicians to specific patient care units improves nurse-physician communication and agreement on patients' plans of care.<h4>Methods</h4>We conducted structured interviews of a cross-sectional sample of nurses and physicians before and after an intervention to localize physicians to specific patient car ...[more]

PMID: 19768510

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Project description:Although previous studies suggest an association between provider burnout and suboptimal self-reported communication, no studies relate physician burnout to observed patient-physician communication behaviors.To investigate the relationship between physician burnout and observed patient-physician communication outcomes in patient-physician encounters.Longitudinal study of enrollment data from a trial of interventions to improve patient adherence to hypertension treatment.Fifteen urban community-based clinics in Baltimore, MD.Forty physicians and 235 of their adult hypertensive patients, with oversampling of ethnic minorities and poor persons. Fifty-three percent of physicians were women, and the average practice experience was 11.2 years. Among the 235 patients, 66% were women, 60% were African-American, and 90% were insured.Audiotape analysis of communication during outpatient encounters (one per patient) using the Roter Interaction Analysis System and patients' ratings of satisfaction with and trust and confidence in the physician.The median time between the physician burnout assessment and the patient encounter was 15.1 months (range 5.6-30). Multivariate analyses revealed no significant differences in physician communication based on physician burnout. However, compared with patients of low-burnout physicians, patients of high-burnout physicians gave twice as many negative rapport-building statements (incident risk ratio 2.06, 95% CI 1.58-2.86, p < 0.001). Physician burnout was not significantly associated with physician or patient affect, patient-centeredness, verbal dominance, or length of the encounter. Physician burnout was also not significantly associated with patients' ratings of their satisfaction, confidence, or trust.Physician burnout was not associated with physician communication behaviors nor with most measures of patient-centered communication. However, patients engaged in more rapport-building behaviors. These findings suggest a complex relationship between physician burnout and patient-physician communication, which should be investigated and linked to patient outcomes in future research.

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Dataset Information

Impact of localizing physicians to hospital units on nurse-physician communication and agreement on the plan of care.

Background

Objective

Methods

Results

Conclusions

Publications

Impact of localizing physicians to hospital units on nurse-physician communication and agreement on the plan of care.

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