Effect of Complementary Interventions to Redesign Care on Teamwork and Quality for Hospitalized Medical Patients

Background: Multiple challenges impede interprofessional teamwork and the provision of high-quality care to hospitalized patients. Objective: To evaluate the effect of interventions to redesign hospital care delivery on teamwork and patient outcomes. Design: Pragmatic controlled trial. Hospitals selected 1 unit for implementation of interventions and a second to serve as a control. (ClinicalTrials.gov: NCT03745677) Setting: Medical units at 4 U.S. hospitals. Participants: Health care professionals and hospitalized medical patients. Intervention: Mentored implementation of unit-based physician teams, unit nurse–physician coleadership, enhanced interprofessional rounds, unit-level performance reports, and patient engagement activities. Measurements: Primary outcomes were teamwork climate among health care professionals and adverse events experienced by patients. Secondary outcomes were length of stay (LOS), 30-day readmissions, and patient experience. Difference-in-differences (DID) analyses of patient outcomes compared intervention versus control units before and after implementation of interventions. Results: Among 155 professionals who completed pre- and postintervention surveys, the median teamwork climate score was higher after than before the intervention only for nurses (n ¼ 77) (median score, 88.0 [IQR, 77.0 to 91.0] vs. 80.0 [IQR, 70.0 to 89.0]; P ¼ 0.022). Among 3773 patients, a greater percentage had at least 1 adverse event after compared with before the intervention on control units (change, 1.61 percentage points [95% CI, 0.01 to 3.22 percentage points]). A similar percentage of patients had at least 1 adverse event after compared with before the intervention on intervention units (change, 0.43 percentage point [CI, -1.25 to 2.12 percentage points]). A DID analysis of adverse events did not show a significant difference in change (adjusted DID, -0.92 percentage point [CI, -2.49 to 0.64 percentage point]; P ¼ 0.25). Similarly, there were no differences in LOS, readmissions, or patient experience. Limitation: Adverse events occurred less frequently than anticipated, limiting statistical power. Conclusion: Despite improved teamwork climate among nurses, interventions to redesign care for hospitalized patients were not associated with improved patient outcomes.