Impact of localizing physicians to hospital units on nurse-physician communication and agreement on the plan of care

Background: A significant barrier to communication among patient care providers in hospitals is the geographic dispersion of team members. Objective: To determine whether localizing physicians to specific patient care units improves nurse-physician communication and agreement on patients' plans of care. Methods: We conducted structured interviews of a cross-sectional sample of nurses and physicians before and after an intervention to localize physicians to specific patient care units. Interviews characterized patterns of nurse-physician communication and assessed understanding of patients' plans of care. Two internists reviewed responses and rated nurse-physician agreement on six aspects of the plan of care as none, partial, or complete agreement. Results: Three hundred eleven of 342 (91%) and 291 of 294 (99%) patients' nurses and 301 of 342 (88%) and 285 of 294 (97%) physicians completed the interview during the pre- and post-localization periods. Two hundred nine of 285 (73%) patients were localized to physicians' designated patient care units in the post-localization period. After localization, a higher percentage of patients' nurses and physicians was able to correctly identify one another (93% vs. 71%; p<0.001 and 58% vs. 36%; p<0.001, respectively). Nurses and physicians reported more frequent communication after localization (68% vs. 50%; p<0.001 and 74% vs. 61%; p<0.001, respectively). Nurse-physician agreement was significantly improved for two aspects of the plan of care: planned tests and anticipated length of stay. Conclusions: Although nurses and physicians were able to identify one another and communicated more frequently after localizing physicians to specific patient care units, there was little impact on nurse-physician agreement on the plan of care.