title: Clinician Perceptions of Teamwork in the Emergency Department: Does Nurse and Medical Provider Workspace Placement Make a Difference?
abstract: OBJECTIVE
  This study was intended to determine whether positioning emergency department (ED) physicians, physician assistants, and nurse practitioners at the same workstations as registered nurses (RNs) improved communication and teamwork.
  
  
  BACKGROUND
  Historically in this organization, providers and staff had separate physical locations (workstations). Construction of a new ED provided the opportunity to redesign the physical layout and to study whether a new design improved the perception of communication and teamwork among medical providers.
  
  
  METHODS
  A prospective, self-administered presurvey-postsurvey using the TeamSTEPPS Teamwork Perceptions Questionnaire (TPQ) was completed at 2 medical centers with the same staff premove and postmove but different ED designs. The presurvey was conducted while the staff were at the older facility with a more linear floor design and separated nurse and physician stations. The postsurvey was conducted 3 months after employees and physicians were relocated to a new hospital with a pod design and communal workstations in the ED.
  
  
  RESULTS
  Forty-six staff members completed both the presurvey and the postsurvey. There was a statistically significant improvement in the total TPQ scores (P = .0009) and 4 of the 5 components of the TPQ: team structure (P = .0283), situation monitoring (P = .0006), mutual support (P < .0001), and communication (P < .0001). There was no change in the leadership component (P = .4519).
  
  
  CONCLUSIONS
  Adopting a more communal physical layout was associated with improved overall TPQ scores and most of the TPQ components. The lack of change in the leadership component was explained by the lack of change in leadership structure. The physical placement of medical providers and RNs in an ED is important and can increase the perception of communication and teamwork and thereby improve patient outcomes.
authors.affiliation: Author Affiliations: Assistant Nurse Manager (Ms Weaver), Chief Nursing Officer (Ms Hernandez), Associate Professor and Staff Nurse (Dr Olson), The University of Texas Southwestern Medical Center, Dallas.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: Susan
authors.initials: S
authors.lastname: Hernandez
authors.forename: Daiwai M
authors.initials: DM
authors.lastname: Olson
mesh_terms: D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology*; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010348:Patient Care Team; D013781:Texas; D017132:Workplace