A team-based inpatient care model was associated with a safer hospitalization and higher quality of care for patients, compared to a traditional team model.
Online PR News – 13-May-2010 – – Boston, MA – In a study comparing traditional inpatient care models with a restructured model that reduced the workload and improved the supervision of junior doctors, researchers at Brigham and Women’s Hospital (BWH) found that the team-based model was associated with a safer hospitalization and higher quality of care for patients. With the new model, there were fewer inpatient deaths, shorter hospital stays, higher medical team satisfaction and increased time for educational activities. The findings are published in the April 7 issue of the New England Journal of Medicine.
Previous studies have demonstrated that poor supervision and a heavy workload lead to increased fatigue-related errors and reduced participation in educational activities. “This association has prompted a call to examine the supervision and education of junior doctors caring for hospitalized patients,” said lead study author Graham McMahon, MD, MMSc, of the Department of Medicine at BWH.
The researchers compared traditional care teams with redesigned care teams that treated approximately 4,000 inpatients over a 12 month period. Hospital staff and trainees provided suggestions on how to create an optimal team structure to care for inpatients. Two of these redesigned teams, known as the integrated teaching unit (ITU), comprised of two teaching attending physicians, two second- or third-year residents and three first-year medical interns working with an integrated team of nurses and other care professionals. The two traditional care teams were comprised of one teaching attend physician, one resident, and two interns.
The patient group admitted to the ITU had a lower in-hospital mortality and decreased length of stay compared to the group admitted to a traditional team. Though patient satisfaction scores were comparatively high for both teams, satisfaction was higher for attendings, residents, and interns in the ITUs compared to those on traditional teams. Interns in the ITUs were also able to spend more time studying, learning, and teaching than traditional-team interns.
“These results finally demonstrate that investing in the training and supervision of junior doctors does not only improve the quality of patient care, but also increases hospital efficiency: it’s a win-win” explains Dr. McMahon.
The study was funded by the Department of Medicine at BWH.
Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit http://www.brighamandwomens.org/.