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Readmission and mortality in patients treated by interprofessional student teams at a training ward compared with patients receiving usual care: a retrospective cohort study.

ABSTRACT: OBJECTIVE:This study aimed to compare the rate of patient readmissions and mortality between care provided at an orthopaedic interprofessional training ward (IPTW) and usual care. DESIGN:Retrospective cohort study. SETTING:Orthopaedic wards at a level II trauma centre at a Swedish university teaching hospital between 2006 and 2011. PARTICIPANTS:Two cohorts were identified: (1) a control cohort that had not received care at the IPTW, and (2) patients who had been treated for at least 1?day at the IPTW. MAIN OUTCOME MEASURES:Readmission at 90 days and 1-year mortality. RESULTS:We included 4652 controls and 1109 in the IPTW group. The mean age was 63 years, and 58% were women. The groups did not differ in any of the outcomes: the readmission rate in the control and IPTW groups was 13.5% and 14.0%, respectively, while mortality was 5.2% and 5.3%, respectively. This lack of difference remained after adjusting for confounders. CONCLUSION:Interprofessional undergraduate training in patient-based settings can be performed in a level II trauma hospital with satisfactory patient safety.

SUBMITTER: Hallin K

PROVIDER: S-EPMC6196845 | biostudies-other | 2018 Oct

REPOSITORIES: biostudies-other

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Readmission and mortality in patients treated by interprofessional student teams at a training ward compared with patients receiving usual care: a retrospective cohort study.

Hallin Karin K Gordon Max M Sköldenberg Olof O Henriksson Peter P Kiessling Anna A

BMJ open 20181018 10

<h4>Objective</h4>This study aimed to compare the rate of patient readmissions and mortality between care provided at an orthopaedic interprofessional training ward (IPTW) and usual care.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>Orthopaedic wards at a level II trauma centre at a Swedish university teaching hospital between 2006 and 2011.<h4>Participants</h4>Two cohorts were identified: (1) a control cohort that had not received care at the IPTW, and (2) patients who had been trea ...[more]

PMID: 30341125

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Project description:Project description: In Germany there is great interest in better preparing learners in the health care professions for interprofessional (IP) collaboration on IP training wards. On the MIA, Mannheim's interprofessional training ward, medical students, nursing apprentices and physiotherapy (PT) trainees learn and practise real patient care in a team under supervision. The concept of the MIA, its implementation and the first evaluation results are reported. During the 2017/18 academic year, 201 medical students, 72 nursing apprentices and 33 PT trainees completed their mandatory placements on the MIA, which they evaluated online at the end of the placement (questions on the organisation of the MIA placement, learning gains, supervision, participant satisfaction, personal insights). The data was analysed according to frequency for each health care profession separately using the Kruskal-Wallis test for comparing the evaluation data between the three participant groups. Results: The response rate was 45% (104 medical students, 16 nursing apprentices, 19 PT trainees). 64% of the medical students considered the placement too short. For 70% of the nursing apprentices, the number of patients to be treated was too high. The supervision by the facilitators was adequate. There were often IP contacts. Professional and IP learning gains were rated high. IP learning took place mainly in personal conversations and on IP ward rounds. IP communication/collaboration was mentioned most often as an important insight gained from the placement. Discussion: The implementation of the MIA concept is considered successful. The learning objectives were achieved. The structured daily routine on the ward with its IP elements promotes IP collaboration and helps to minimise difficulties in the clinical placement, which - often for the first time - demands that the participants manage patient care in an accountable manner. Conclusion: Placements on IP training wards in the education of health care professionals can be a good preparation for practising optimal patient care in the future.

Project description:AimThe aim of the study was to describe practices that support collaboration in interprofessional primary health care teams, and identify performance indicators perceived to measure the impact of this collaboration from the perspective of interprofessional health providers.BackgroundDespite the surge of interprofessional primary health care models implemented across Canada, there is little evidence as to whether or not the intended outcomes of primary health care teams have been achieved. Part of the challenge is determining the most appropriate measures that can demonstrate the value of collaborative care. To date, little remains known about performance measurement from the providers contributing to the collaborative care process in interprofessional primary care teams. Having providers from a range of disciplinary backgrounds assist in the development of performance measures can help identify measures most relevant to demonstrate the value of collaborative care on the intended outcomes of interprofessional primary care models.MethodsA qualitative study; part of a larger mixed methods developmental evaluation to examine performance measurement in interprofessional primary health care teams. A stakeholder workshop was conducted at an annual association meeting of interprofessional primary health care teams in the province of Ontario, Canada. Six questions guided the workshop groups and participant responses were documented on worksheets and flip charts. All responses were collected and entered verbatim into a word document. Qualitative analytic strategies were applied to each question.FindingsA total of 283 primary health care providers from 14 health professions working in interprofessional primary health care teams participated. Top three elements of interprofessional collaboration (total n = 628) were communication (n = 146), co-treatment (n = 112) and patient-based conferences (n = 81). Top three performance indicators currently used to demonstrate the value of interprofessional collaboration (total n = 241) were patient experience (n = 71), patient health status (n = 35) and within team referrals (n = 30).

Project description:BackgroundWhen working in complex environments with critically ill patients, team performance is influenced by situation awareness in teams. Moreover, improved situation awareness in the teams will probably improve team and task performance. The aim of this study is to evaluate an educational programme on situation awareness for interprofessional teams at the intensive care units using team and task performance as outcomes.MethodTwenty interprofessional teams from the northern part of Sweden participated in this randomized controlled intervention study conducted in situ in two intensive care units. The study was based on three cases (cases 0, 1 and 2) with patients in a critical situation. The intervention group (n = 11) participated in a two-hour educational programme in situation awareness, including theory, practice, and reflection, while the control group (n = 9) performed the training without education in situation awareness. The outcomes were team performance (TEAM instrument), task performance (ABCDE checklist) and situation awareness (Situation Awareness Global Assessment Technique (SAGAT)). Generalized estimating equation were used to analyse the changes from case 0 to case 2, and from case 1 to case 2.ResultsEducation in situation awareness in the intervention group improved TEAM leadership (p = 0.003), TEAM task management (p = 0.018) and TEAM total (p = 0.030) when comparing cases 1 and 2; these significant improvements were not found in the control group. No significant differences were observed in the SAGAT or the ABCDE checklist.ConclusionsThis intervention study shows that a 2-h education in situation awareness improved parts of team performance in an acute care situation. Team leadership and task management improved in the intervention group, which may indicate that the one or several of the components in situation awareness (perception, comprehension and projection) were improved. However, in the present study this potential increase in situation awareness was not detected with SAGAT. Further research is needed to evaluate how educational programs can be used to increase situation awareness in interprofessional ICU teams and to establish which components that are essential in these programs.Trial registrationThis randomized controlled trial was not registered as it does not report the results of health outcomes after a health care intervention on human participants.

Project description:Theory:Individuals have different qualities, levels of willingness, and degrees of engagement for working in teams. This behaviour is termed 'Collective Orientation' (CO). Collective orientation can be trained and has a positive influence on team processes. Here, we investigated the effect of a simulator-based, Crisis Resource Management team training upon the participants' CO. Hypotheses:We hypothesized (1) the scales of CO and Presence for lab-based microworld research (PLBMR) are applicable to the German anaesthesia teams, (2) the CO can be influenced by means of simulation training, (3) the training effect is dependent on sex and/or profession, and (4) the change of CO depends on the perceived presence of the participants in the scenario. Method:In a pre-post study, 66 nurses and doctors from various anaesthetic departments took part in a 1-day training course to improve non-technical skills. The primary outcome was the mean difference between the CO measured (via questionnaires) immediately before (T1) and after (T2) training. The change was then tested for dependence upon other variables, such as sex, professional group, and immersion into the simulation scenarios. Results:Collective orientation improved significantly after training (mean difference: 0.2; P?<?.001; dz?=?0.53). Considering the subscales, affiliation increased significantly (P?<?.001; dz?=?0.59), whereas dominance remained unchanged. Furthermore, no correlation was found regarding sex, professional group, or immersion into the simulation scenarios. Conclusions:Our study demonstrated that simulation-based training improves the participants' COs, primarily by increasing affiliation. Subjective scenario reality did not significantly influence this. Nonetheless, it remains unclear as to what factors categorically resulted in this benefit. The shared experience in the course by all team members might trigger the effects. However, further studies are needed to identify the modifiable factors that can improve teamwork attitudes.

Dataset Information

Readmission and mortality in patients treated by interprofessional student teams at a training ward compared with patients receiving usual care: a retrospective cohort study.

Publications

Readmission and mortality in patients treated by interprofessional student teams at a training ward compared with patients receiving usual care: a retrospective cohort study.

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