title: Impact of localizing physicians to hospital units on nurse-physician communication and agreement on the plan of care.
abstract: BACKGROUND
  A significant barrier to communication among patient care providers in hospitals is the geographic dispersion of team members.
  
  
  OBJECTIVE
  To determine whether localizing physicians to specific patient care units improves nurse-physician communication and agreement on patients' plans of care.
  
  
  METHODS
  We conducted structured interviews of a cross-sectional sample of nurses and physicians before and after an intervention to localize physicians to specific patient care units. Interviews characterized patterns of nurse-physician communication and assessed understanding of patients' plans of care. Two internists reviewed responses and rated nurse-physician agreement on six aspects of the plan of care as none, partial, or complete agreement.
  
  
  RESULTS
  Three hundred eleven of 342 (91%) and 291 of 294 (99%) patients' nurses and 301 of 342 (88%) and 285 of 294 (97%) physicians completed the interview during the pre- and post-localization periods. Two hundred nine of 285 (73%) patients were localized to physicians' designated patient care units in the post-localization period. After localization, a higher percentage of patients' nurses and physicians was able to correctly identify one another (93% vs. 71%; p < 0.001 and 58% vs. 36%; p < 0.001, respectively). Nurses and physicians reported more frequent communication after localization (68% vs. 50%; p < 0.001 and 74% vs. 61%; p < 0.001, respectively). Nurse-physician agreement was significantly improved for two aspects of the plan of care: planned tests and anticipated length of stay.
  
  
  CONCLUSIONS
  Although nurses and physicians were able to identify one another and communicated more frequently after localizing physicians to specific patient care units, there was little impact on nurse-physician agreement on the plan of care.
authors.affiliation: Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 259 E. Erie Street, Chicago, IL 60611, USA. keoleary@nmh.org
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: O'Leary
authors.forename: Diane B
authors.initials: DB
authors.lastname: Wayne
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Landler
authors.forename: Nita
authors.initials: N
authors.lastname: Kulkarni
authors.forename: Corinne
authors.initials: C
authors.lastname: Haviley
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Hahn
authors.forename: Jiyeon
authors.initials: J
authors.lastname: Jeon
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Englert
authors.forename: Mark V
authors.initials: MV
authors.lastname: Williams
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006757:Hospital Units; D006801:Humans; D008297:Male; D009726:Nurses / Q000523:psychology; D005791:Patient Care / Q000379:methods*; D010348:Patient Care Team; D019555:Physician-Nurse Relations; D010820:Physicians / Q000523:psychology; D055815:Young Adult