Effects of a multicentre teamwork and communication programme on patient outcomes: results from the Triad for Optimal Patient Safety (TOPS) project. Issue 2 (7th November 2011)

• Record Type: Journal Article
• Authors: Auerbach, Andrew D; Sehgal, Niraj L; Blegen, Mary A; Maselli, Judith; Alldredge, Brian K; Vittinghoff, Eric; Wachter, Robert M
• Is Part Of: BMJ quality & safety. Volume 21:Issue 2(2012)
• Page Start: 118
• Page End: 126
• Publication Date: 2011-11-07
• Subjects: Quality improvement methodologies -- quality measurement -- health services research -- patient safety -- incident reporting -- healthcare quality improvement -- hospital medicine -- quality improvement -- health policy; Medical care -- Quality control -- Periodicals; Health facilities -- Risk management -- Periodicals; Medical errors -- Prevention -- Periodicals; 362.106805
• DOI: 10.1136/bmjqs-2011-000311
• Languages: English
• ISSNs: 2044-5415

Abstract

Abstract : Background: Improving communication between caregivers is an important approach to improving safety. Objective: To implement teamwork and communication interventions and evaluate their impact on patient outcomes. Design: A prospective, interrupted time series of a three-phase intervention: a run-in period (phase 1), during which a training programme was given to providers and staff on each unit; phase 2, which focused on unit-based safety teams to identify and address care problems using skills from phase 1; and phase 3, which focused on engaging patients in communication efforts. Setting: General medical inpatient units at three northern California hospitals. Patients: Administrative data were collected from all adults admitted to the target units, and a convenience sample of patients interviewed during and after hospitalisation. Measurements: Readmission, length of stay and patient reports of teamwork, problems with care, and overall satisfaction. Results: 10 977 patients were admitted; 581 patients (5.3% of total sample) were interviewed in hospital, and 313 (2.9% overall, 53.8% of interviewed patients) completed 1-month surveys. No phase of the study was associated with adjusted differences in readmission or length of stay. The phase 2 intervention appeared to be associated with improvement in reports of whether physicians treated them with respect, whether nurses treated them with respect or understood their needs (p<0.05 for all). Interestingly, patients were more likely to perceive that an error took place with their care and agreed less that their caregivers worked well together as a team. No phase had a consistent impact on patient reports of care processes or overall satisfaction. Limitations: The study lacks direct measures of patient safety. Conclusions: Efforts to simultaneously improve caregivers' ability to troubleshoot care and enhance communication may improve patients' perception of team functions, but may also increase patients' perception of safety gaps.