Impact of regionalized care on concordance of plan and preventable adverse events on general medicine services.

Background: Dispersion of inpatient care teams across different medical units impedes effective team communication, potentially leading to adverse events (AEs).

Objective: To regionalize 3 inpatient general medical teams to nursing units and examine the association with communication and preventable AEs.

Design: Pre-post cohort analysis.

Setting: A 700-bed academic medical center.

Patients: General medicine patients on any of the participating nursing units before and after implementation of regionalized care.

Intervention: Regionalizing 3 general medical physician teams to 3 corresponding nursing units.

Measurements: Concordance of patient care plan between nurse and intern, and adjusted odds of preventable AEs.

Results: Of the 414 included nurse and intern paired surveys, there were no significant differences pre- versus postregionalization in total mean concordance scores (0.65 vs 0.67, P = 0.26), but there was significant improvement in agreement on expected discharge date (0.56 vs 0.68, P = 0.003), knowledge of the other provider's name (0.56 vs 0.86,P < 0.001), and daily care plan discussions (0.73 vs 0.88, P < 0.001). Of the 392 reviewed patient medical records, there was no significant difference in the adjusted odds of preventable AEs pre- versus postregionalization (adjusted odds ratio: 1.37, 95% confidence interval: 0.69, 2.69).

Conclusions: We found that regionalization of care teams improved recognition of care team members, discussion of daily care plan, and agreement on estimated discharge date, but did not significantly improve nurse and physician concordance of the care plan or reduce the odds of preventable AEs. Our findings suggest that regionalization alone may be insufficient to effectively promote communication and lead to patient safety improvements. Journal of Hospital Medicine 2016;11:620-627. © 2016 Society of Hospital Medicine.