title: Unit-based care teams and the frequency and quality of physician-nurse communications.
abstract: OBJECTIVE
  To determine whether reorganizing physicians into unit-based teams in general pediatric wards is associated with greater ability to identify other care team members, increased face-to-face communication between physicians and nurses, greater perception that their patient care concerns were met, and decreased number of pages to residents.
  
  
  METHODS
  Prospective intervention study with data collected before and at 2 time points after implementation of unit-based teams.
  
  
  METHODS
  General pediatric wards at an urban, tertiary care, freestanding children's hospital from April 1, 2008, through June 30, 2009.
  
  
  METHODS
  Pediatric residents rotating in the medical wards (n = 60) and ward-based pediatric nurses (n = 154).
  
  
  METHODS
  We reorganized resident-physician care teams to be based on specific inpatient units, with residents admitting and caring only for patients on their assigned unit.
  
  
  METHODS
  Anonymous physician and nurse self-reports of communication practices and number of pages residents received.
  
  
  RESULTS
  In the unit-based team system, physicians were more likely to be able to identify the nurse for their patients with the most complex conditions (62.3% vs 82.8% vs 82.5%, P = .05), to report contacting (27.3% vs 64.9% vs 56.9%, P = .01) and being contacted by (7.7% vs 48.2% vs 55.2%, P = .002) that nurse in person, and to believe their patient care concerns were met (44.2% vs 82.1% vs 81.8%, P = .009). Nurses reported parallel improvements in communication patterns. The mean number of pages per day to residents decreased by 42.1% (19 vs 10 vs 11, P < .001).
  
  
  CONCLUSIONS
  Unit-based teams improve the frequency and quality of multidisciplinary communication, which may create an improved climate for patient safety.
authors.affiliation: Division of General Pediatrics, Department of Medicine, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA. mbgordon@post.harvard.edu
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Gordon
authors.forename: Patrice
authors.initials: P
authors.lastname: Melvin
authors.forename: Dionne
authors.initials: D
authors.lastname: Graham
authors.forename: Emily
authors.initials: E
authors.lastname: Fifer
authors.forename: Vincent W
authors.initials: VW
authors.lastname: Chiang
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Sectish
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Landrigan
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D008297:Male; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010372:Pediatrics / Q000458:organization & administration; D019555:Physician-Nurse Relations; D011446:Prospective Studies; D017749:Total Quality Management; D014481:United States