title: Effects of Interdisciplinary Team Care Interventions on General Medical Wards: A Systematic Review.
abstract: OBJECTIVE
  Improving the quality of health care for general medical patients is a priority, but the organization of general medical ward care receives less scrutiny than the management of specific diseases. Optimizing teams' performance improves patient outcomes in other settings, and interdisciplinary practice is a major target for improvement efforts. However, the effect of interdisciplinary team interventions on general medical ward care has not been systematically reviewed.
  
  
  OBJECTIVE
  To describe the range of objective patient outcomes used in studies of general medical ward interdisciplinary team care, and to evaluate the performance of interdisciplinary interventions against them.
  
  
  METHODS
  We searched EMBASE, MEDLINE, and PsycINFO from January 1, 1998, through December 31, 2013, for interdisciplinary team care interventions in adult general medical wards using an objective patient outcome measure. Reference lists of included articles were also searched. The last search was conducted on January 29, 2014, and the narrative and statistical analysis was conducted through December 1, 2014. Study quality was assessed using the Cochrane Effective Practice and Organization of Care group's tool.
  
  
  RESULTS
  Thirty of 6934 articles met the selection criteria. The studies included 66,548 patients, with a mean age of 63 years. Nineteen of 30 (63%) studies reported length of stay, readmission, or mortality rate as their primary outcome, or did not specify the primacy of their outcomes. The most commonly reported objective patient outcomes were length of stay (23 of 30 [77%]), complications of care (10 of 30 [33%]), in-hospital mortality rate (8 of 30 [27%]), and 30-day readmission rate (8 of 30 [27%]). Of 23 interventions, 16 (70%) had no effect on length of stay, 12 of 15 (80%) did not reduce readmissions, and 14 of 15 (93%) did not affect mortality. Five of 10 (50%) interventions reduced complications of care. In an exploratory quantitative analysis, the interventions did not consistently reduce the relative risk of early readmission or early mortality, or the weighted mean difference in length of stay. All studies had a medium or high risk of bias.
  
  
  CONCLUSIONS
  Current evidence suggests that interdisciplinary team care interventions on general medical wards have little effect on traditional measures of health care quality. Complications of care or preventable adverse events may merit inclusion as quality indicators for general medical wards. Future study should clarify how best to implement interdisciplinary team care interventions and establish quality metrics that are credible to both health care professionals and patients in this setting.
authors.affiliation: Imperial Patient Safety Translational Research Center, National Institute for Health Research and Imperial College London, London, England2West Middlesex University Hospital National Health Service Trust, Middlesex, England.
authors.forename: Samuel
authors.initials: S
authors.lastname: Pannick
authors.affiliation: Imperial Patient Safety Translational Research Center, National Institute for Health Research and Imperial College London, London, England.
authors.forename: Rachel
authors.initials: R
authors.lastname: Davis
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, England.
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.affiliation: Imperial Patient Safety Translational Research Center, National Institute for Health Research and Imperial College London, London, England.
authors.forename: Ben E
authors.initials: BE
authors.lastname: Byrne
authors.affiliation: West Middlesex University Hospital National Health Service Trust, Middlesex, England.
authors.forename: Iain
authors.initials: I
authors.lastname: Beveridge
authors.affiliation: Department of Surgery and Cancer, Imperial College London, London, England.
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.affiliation: Division of Hospital Medicine, University of California, San Francisco.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Wachter
authors.affiliation: Imperial Patient Safety Translational Research Center, National Institute for Health Research and Imperial College London, London, England5Center for Implementation Science, Health Service & Population Research Department, King's College London, London, E.
authors.forename: Nick
authors.initials: N
authors.lastname: Sevdalis
mesh_terms: D017052:Hospital Mortality; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D010348:Patient Care Team; D010359:Patient Readmission; D058996:Quality Improvement; D011787:Quality of Health Care