title: An academic hospitalist model to improve healthcare worker communication and learner education: results from a quasi-experimental study at a Veterans Affairs medical center.
abstract: BACKGROUND
  Although hospitalists may improve efficiency and quality of inpatient care, their effect on healthcare-worker communication and education has been less well-studied.
  
  
  OBJECTIVE
  To test various approaches to improving healthcare-worker communication and learner education within the context of a newly designed academic hospital medicine program.
  
  
  METHODS
  Before-and-after design with concurrent control group.
  
  
  METHODS
  A Midwestern Veterans Affairs medical center.
  
  
  METHODS
  Multimodal systems redesign of 1 of 4 medical teams (Gold team) that included clinical modifications (change in rounding structure, with inclusion of nurses, a Clinical Care Coordinator, and a pharmacist) and educational interventions (providing explicit expectations of learners and providing a reading list for both learners and attending physicians).
  
  
  METHODS
  Number of admissions, length of stay, readmissions, house officer and medical student ratings of attendings' teaching, medical student internal medicine National Board of Medical Examiners Subject Examination ("shelf" exam) scores, and clinical staff surveys.
  
  
  RESULTS
  Length of stay was reduced by about 0.3 days on all teams after the initiative began (P = 0.004), with no significant differences between Gold and non-Gold teams. The majority of physicians (83%) and nurses (68%) felt that including nurses during rounds improved healthcare-worker communication; significantly more nurses were satisfied with communication with the Gold team than with the other teams (71% vs 53%; P = 0.02). Gold attendings generally received higher teaching scores compared with non-Gold attendings, and third-year medical students on the Gold team scored significantly higher on the shelf exam compared with non-Gold team students (84 vs 82; P = 0.006).
  
  
  CONCLUSIONS
  Academic hospitalists working within a systems redesign intervention were able to improve healthcare-worker communication and enhance learner education without increasing patient length of stay or readmission rates.
authors.affiliation: VA Ann Arbor Healthcare System, Ann Arbor, Michigan; VA Ann Arbor Hospital Outcomes Program of Excellence (HOPE) Initiative, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
authors.forename: Karen E
authors.initials: KE
authors.lastname: Fowler
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Krein
authors.forename: Scott A
authors.initials: SA
authors.lastname: Flanders
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Bodnar
authors.forename: Eric
authors.initials: E
authors.lastname: Young
authors.forename: Richard H
authors.initials: RH
authors.lastname: Moseley
mesh_terms: D003142:Communication; D005260:Female; D006282:Health Personnel / Q000193:education / Q000592:standards / Q000639:trends; D020445:Hospitalists / Q000193:education* / Q000592:standards* / Q000639:trends; D006787:Hospitals, Veterans / Q000592:standards* / Q000639:trends; D006801:Humans; D007396:Internship and Residency / Q000592:standards / Q000639:trends; D008297:Male; D009726:Nurses / Q000592:standards / Q000639:trends; D010348:Patient Care Team / Q000592:standards* / Q000639:trends; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards* / Q000639:trends