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Regionalized care teams may not lead to improvements in patient safety, study finds

Regionalized, multidisciplinary care teams that care for patients on the same hospital unit do not appear to reduce the odds of preventable adverse events, although there may be team-related benefits, according to a recent study.

The cohort analysis assessed the effects of regionalization of care on general medicine teams at a 700-bed tertiary care center. Results were published online on Feb. 24 by the Journal of Hospital Medicine.

Prior to regionalization, physician care teams on the general medicine service each consisted of 1 hospitalist attending, 1 resident, and 2 interns, who would care for patients on an average of 7 and up to a maximum of 13 different nursing units per day. Regionalized care made it so that each of 3 teams was localized to one of three 15-bed nursing units.

In 392 studied patients (198 pre-intervention, 194 post-intervention), there were no significant differences in age, sex, race, language, length of stay, or Elixhauser comorbidity scores pre- versus post-regionalization. Using these patients' medical records, researchers found no significant difference in the adjusted odds of preventable adverse events before and after the intervention (adjusted odds ratio, 1.37; 95% CI, 0.69 to 2.69).

Researchers also administered surveys to 361 unique nurse and intern pairs to examine concordance regarding the discussion of patient care plans, as well as other aspects of care. They found no significant differences pre- versus post-regionalization in total mean concordance scores (0.65 vs. 0.67, P=0.26), but there was significant improvement in scores for agreement on the expected discharge date (0.56 vs. 0.68, P=0.003), nurse's knowledge of the intern's name (0.56 vs. 0.88, P<0.001), and daily care plan discussions (0.73 vs. 0.88, P<0.001).

The study's authors noted several limitations to their work, such as how the single-center study may not be generalizable to other institutions and how the concordance survey has not been formally validated. In addition, the screening tool for adverse events looked for specific types and may have missed more subtle adverse events. The study also omitted other clinically important outcomes and measures of workplace culture that regionalization efforts could have positively or negatively impacted.

In addition, the authors noted that patient volume increased by almost one-third post-regionalization, which may have influenced their findings. “...[T]hus, another way to state our results is that we were able to increase the daily volume of patients without any significant decreases in patient safety,” they wrote. “Nevertheless, the results on patient safety were less than desired.”