Effects of a multicentre teamwork and communication programme on patient outcomes: results from the Triad for Optimal Patient Safety (TOPS) project.

Background: Improving communication between caregivers is an important approach to improving safety.

Objective: To implement teamwork and communication interventions and evaluate their impact on patient outcomes.

Design: A prospective, interrupted time series of a three-phase

Intervention: a run-in period (phase 1), during which a training programme was given to providers and staff on each unit; phase 2, which focused on unit-based safety teams to identify and address care problems using skills from phase 1; and phase 3, which focused on engaging patients in communication efforts.

Setting: General medical inpatient units at three northern California hospitals.

Patients: Administrative data were collected from all adults admitted to the target units, and a convenience sample of patients interviewed during and after hospitalisation.

Measurements: Readmission, length of stay and patient reports of teamwork, problems with care, and overall satisfaction.

Results: 10 977 patients were admitted; 581 patients (5.3% of total sample) were interviewed in hospital, and 313 (2.9% overall, 53.8% of interviewed patients) completed 1-month surveys. No phase of the study was associated with adjusted differences in readmission or length of stay. The phase 2 intervention appeared to be associated with improvement in reports of whether physicians treated them with respect, whether nurses treated them with respect or understood their needs (p<0.05 for all). Interestingly, patients were more likely to perceive that an error took place with their care and agreed less that their caregivers worked well together as a team. No phase had a consistent impact on patient reports of care processes or overall satisfaction. Limitations The study lacks direct measures of patient safety.

Conclusions: Efforts to simultaneously improve caregivers' ability to troubleshoot care and enhance communication may improve patients' perception of team functions, but may also increase patients' perception of safety gaps.