• Kevin J O'Leary, Julie K Johnson, Mark V Williams, Ronald Estrella, Krystal Hanrahan, Luci K Leykum, G Randy Smith, Jenna D Goldstein, Jane S Kim, Sara Thompson, Iva Terwilliger, Jing Song, Jungwha Lee, and Milisa Manojlovich.
• Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois (K.J.O., G.R.S., J.S.K.).
• Ann. Intern. Med. 2023 Nov 1; 176 (11): 145614641456-1464.

BackgroundMultiple challenges impede interprofessional teamwork and the provision of high-quality care to hospitalized patients.ObjectiveTo evaluate the effect of interventions to redesign hospital care delivery on teamwork and patient outcomes.DesignPragmatic controlled trial. Hospitals selected 1 unit for implementation of interventions and a second to serve as a control. (ClinicalTrials.gov: NCT03745677).SettingMedical units at 4 U.S. hospitals.ParticipantsHealth care professionals and hospitalized medical patients.InterventionMentored implementation of unit-based physician teams, unit nurse-physician coleadership, enhanced interprofessional rounds, unit-level performance reports, and patient engagement activities.MeasurementsPrimary outcomes were teamwork climate among health care professionals and adverse events experienced by patients. Secondary outcomes were length of stay (LOS), 30-day readmissions, and patient experience. Difference-in-differences (DID) analyses of patient outcomes compared intervention versus control units before and after implementation of interventions.ResultsAmong 155 professionals who completed pre- and postintervention surveys, the median teamwork climate score was higher after than before the intervention only for nurses (n = 77) (median score, 88.0 [IQR, 77.0 to 91.0] vs. 80.0 [IQR, 70.0 to 89.0]; P = 0.022). Among 3773 patients, a greater percentage had at least 1 adverse event after compared with before the intervention on control units (change, 1.61 percentage points [95% CI, 0.01 to 3.22 percentage points]). A similar percentage of patients had at least 1 adverse event after compared with before the intervention on intervention units (change, 0.43 percentage point [CI, -1.25 to 2.12 percentage points]). A DID analysis of adverse events did not show a significant difference in change (adjusted DID, -0.92 percentage point [CI, -2.49 to 0.64 percentage point]; P = 0.25). Similarly, there were no differences in LOS, readmissions, or patient experience.LimitationAdverse events occurred less frequently than anticipated, limiting statistical power.ConclusionDespite improved teamwork climate among nurses, interventions to redesign care for hospitalized patients were not associated with improved patient outcomes.Primary Funding SourceAgency for Healthcare Research and Quality.

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