Clinical question: Does an increased familiarity between medical residents and nurses improve team performance and communication?
Background: Prior studies suggest that familiarity promotes an environment of safety, in which providers are comfortable speaking up, asking for help, and admitting errors. Failures in team communication are often cited as contributors to medical errors.
Study design: a 12-month, randomized, controlled trial
Setting: Single quaternary medical facility
Synopsis: 15 randomly selected PGY-1 internal medicine residents were assigned to the intervention group, spending four month-long general-medicine rotations on the same floor for a year. 18 PGY-1 residents made up the control group and were randomly assigned to one of five floors for each of their rotations. Physician rounds and multidisciplinary rounds were structured similarly on each floor. Team performance on medical simulations, time-motion observations of communication, and surveys were assessed for both the intervention and control groups.
At the end of 12 months, the intervention group had higher performance on a medical simulation, achieving a higher score for leadership and management (composite teamwork score 2.47 versus 2.17; P=0.045), and were more likely to work as a single unit and negotiate with the patient to achieve the desired outcome. Intervention teams were more likely to have nurses present when rounding on patients (47% versus 28%; P=0.03). Surveys at six months found that nurses were more likely to report an excellent to outstanding relationship with PGY-1 residents in the intervention group (74% versus 40%; P=0.003); differences diminished after 12 months.
Limitations include Covid-19-related study interruptions, differences in baseline performance on an initial simulation, technical difficulties limiting analysis of simulations in some of the intervention and control groups, and that the study was performed at a single institution.
Bottom line: Increased familiarity between residents and nurses resulted in improved performance on complex tasks in medical simulations and improved interprofessional communication.
Citation: Iyasere CA, et al. Effect of increased interprofessional familiarity on team performance, communication, and psychological safety on inpatient medical teams. JAMA Intern Med. 2022;182(11):1190-8.
Dr. Huang is a professor of medicine and physician advisor at the University of California, San Diego.