Optimizing Medical "Teaming" on Resident Based Teams
- Conditions
- Inter-professional Relations
- Interventions
- Behavioral: Co-Localization with Nursing
- Registration Number
- NCT05213117
- Lead Sponsor
- Massachusetts General Hospital
- Brief Summary
The main objective of this study is to evaluate the colocalization of internal medicine residents on one clinical inpatient hospital floor for all general medicine block rotations during the 2019-2020 academic year. Specifically, the aims of the study are to determine if co-localization improves familiarity with nursing staff, which in turn, improves team work, psychological safety, patient care and reduces burnout. The investigators' hypothesis is that co-localization will increase familiarity between residents and nurses and result in improved psychological safety, team work and patient outcomes.
- Detailed Description
Teamwork is critical in delivering high quality medical care. Failures in team communication and coordination have been cited as significant contributors to medical errors. In large teaching hospitals, patients receive care from transiently formed teams of nurses and residents who may only work together for as little as two weeks, as residents rotate through many clinical floors due to the complexity of resident scheduling. Unlike more established teams that work together over long periods of time, these transient groups are called "teaming;" a process where a group of diverse providers, with different roles, outlooks and levels of professional training transiently come together to carry out complex tasks. (Reference: Dr. Amy Edmondson, Harvard Business School) A key risk in "teaming" is the lack of familiarity of team members as studies suggest familiarity promotes an environment of psychological safety, where team members feel safe speaking up, asking for help and admitting errors. These skills are important for both team work and patient safety. The investigators hypothesize that in large residency programs where resident rotate on multiple floors, it is possible to improve the quality of "teaming" by increasing the frequency with which smaller groups of residents and nurses work together. As a result, the investigators propose a randomized controlled trial on an inpatient general medical floor to study the effect of co-localizing residents with nursing staff. One cohort of residents will be assigned to complete all general medical rotations on a single floor for the academic year. The investigators will assess the impact on psychological safety, team work and patient care. The investigators hypothesize by co-localizing residents with nursing, while these "teaming" are still transient, the slight increase in familiarity will promote a culture of psychological safety and improve team work. If benefits are found, resident scheduling can be adjusted in subsequent years.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 33
- All incoming PGY-1 residents who volunteer to be randomized
- Any incoming PGY-1 resident who declines to be randomized
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Co-localized Residents Co-Localization with Nursing Investigators plan to randomize 15 PGY-1 residents in internal medicine from the possible 74 PGY-1 incoming residents who agree to partake in the study, to one general medicine clinical floor for the academic year. These co-localized residents will complete 16-20 weeks of scheduled rotation time on White 9
- Primary Outcome Measures
Name Time Method Teamwork assessed by Simulation about Negotiation with Angry Patient This simulation will be conducted at 12 months in this 12month study Simulation of an inpatient clinical scenario will be conducted. This simulation about negotiating with an angry patient will be run with teams consisting of two residents and two nurses. These interdisciplinary teams will be asked to manage a patient together. All residents and nurses in the study will be asked to participate in the simulation. The simulations will be recorded. Blinded reviewers will view these simulations later and will score the team's performance using an published Oxford NOTECH simulation teamwork assessment tool. The assessment tool is designed to identify higher functioning teams by evaluating leadership, communication, shared mental models and utilization of resources.
Teamwork assessed by Simulation about Shortness of Breath This simulation will be conducted at 6 months in this 12month study Simulation of an inpatient clinical scenario will be conducted. This simulation about shortness of breath will be run with teams consisting of two residents and two nurses. These interdisciplinary teams will be asked to manage a patient together. All residents and nurses in the study will be asked to participate in the simulation. The simulations will be recorded. Blinded reviewers will view these simulations later and will score the team's performance using an published Oxford NOTECH simulation teamwork assessment tool. The assessment tool is designed to identify higher functioning teams by evaluating leadership, communication, shared mental models and utilization of resources.
- Secondary Outcome Measures
Name Time Method Psychological Safety Residents and Nurses will be surveyed at 12 months in this 12 month study A survey tool has been developed for both residents and nurses. The survey tool asks questions using a 5 point Likert scale about psychological safety, communication and teamwork. The questions were modified based on prior published work by Dr. Amy Edmondson at the Harvard Business School. The survey will be used to evaluate the residents and nurses perception of teamwork and psychological safety.
Communication between Nurses and Interns Observation will start at 6 months in this 12 month study and continue through study completion, an average of 6 months A time motion study will be conducted where an observer with an Apple iPad will observe rounds with nurses and interns. The observer will record the amount of time each individual is speaking, the length of rounds and the number of patients rounded on.
Trial Locations
- Locations (1)
Massachusetts General Hospital
🇺🇸Boston, Massachusetts, United States