Unit-Based Care Teams and the Frequency and Quality of Physician-Nurse Communications

Objective: To determine whether reorganizing physicians into unit-based teams in general pediatric wards is associated with greater ability to identify other care team members, increased face-to-face communication between physicians and nurses, greater perception that their patient care concerns were met, and decreased number of pages to residents. Design: Prospective intervention study with data collected before and at 2 time points after implementation of unit-based teams. Setting: General pediatric wards at an urban, tertiary care, freestanding children's hospital from April 1, 2008, through June 30, 2009. Participants: Pediatric residents rotating in the medical wards (n = 60) and ward-based pediatric nurses (n = 154). Intervention: We reorganized resident-physician care teams to be based on specific inpatient units, with residents admitting and caring only for patients on their assigned unit. Main Outcome Measures: Anonymous physician and nurse self-reports of communication practices and number of pages residents received. Results: In the unit-based team system, physicians were more likely to be able to identify the nurse for their patients with the most complex conditions (62.3% vs 82.8% vs 82.5%, P =. 05), to report contacting (27.3% vs 64.9% vs 56.9%, P =. 01) and being contacted by (7.7% vs 48.2% vs 55.2%, P =. 002) that nurse in person, and to believe their patient care concerns were met (44.2% vs 82.1% vs 81.8%, P =. 009). Nurses reported parallel improvements in communication patterns. The mean number of pages per day to residents decreased by 42.1% (19 vs 10 vs 11, P < .001). Conclusion: Unit-based teams improve the frequency and quality of multidisciplinary communication, which may create an improved climate for patient safety.