Optimizing Medical "Teaming" on Resident Based Teams

Mass General Brigham

Status: Completed

Conditions: Inter-professional Relations

Treatments: Behavioral: Co-Localization with Nursing

Study type: Interventional

Funder types: Other

Identifiers

NCT05213117

Protocol #: 2019P000534

Details and patient eligibility

About

The main objective of this study is to evaluate the colocalization of internal medicine residents on one clinical inpatient hospital floor for all general medicine block rotations during the 2019-2020 academic year. Specifically, the aims of the study are to determine if co-localization improves familiarity with nursing staff, which in turn, improves team work, psychological safety, patient care and reduces burnout. The investigators' hypothesis is that co-localization will increase familiarity between residents and nurses and result in improved psychological safety, team work and patient outcomes.

Full description

Teamwork is critical in delivering high quality medical care. Failures in team communication and coordination have been cited as significant contributors to medical errors. In large teaching hospitals, patients receive care from transiently formed teams of nurses and residents who may only work together for as little as two weeks, as residents rotate through many clinical floors due to the complexity of resident scheduling. Unlike more established teams that work together over long periods of time, these transient groups are called "teaming;" a process where a group of diverse providers, with different roles, outlooks and levels of professional training transiently come together to carry out complex tasks. (Reference: Dr. Amy Edmondson, Harvard Business School) A key risk in "teaming" is the lack of familiarity of team members as studies suggest familiarity promotes an environment of psychological safety, where team members feel safe speaking up, asking for help and admitting errors. These skills are important for both team work and patient safety. The investigators hypothesize that in large residency programs where resident rotate on multiple floors, it is possible to improve the quality of "teaming" by increasing the frequency with which smaller groups of residents and nurses work together. As a result, the investigators propose a randomized controlled trial on an inpatient general medical floor to study the effect of co-localizing residents with nursing staff. One cohort of residents will be assigned to complete all general medical rotations on a single floor for the academic year. The investigators will assess the impact on psychological safety, team work and patient care. The investigators hypothesize by co-localizing residents with nursing, while these "teaming" are still transient, the slight increase in familiarity will promote a culture of psychological safety and improve team work. If benefits are found, resident scheduling can be adjusted in subsequent years.

Enrollment: 33 patients

Sex: All

Ages: 24+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• All incoming PGY-1 residents who volunteer to be randomized

Exclusion criteria

• Any incoming PGY-1 resident who declines to be randomized

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)

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33 participants in 2 patient groups

Co-localized Residents

Experimental group

Description:

Investigators plan to randomize 15 PGY-1 residents in internal medicine from the possible 74 PGY-1 incoming residents who agree to partake in the study, to one general medicine clinical floor for the academic year. These co-localized residents will complete 16-20 weeks of scheduled rotation time on White 9

Treatment:

Behavioral: Co-Localization with Nursing

Normally Schedule Residents

No Intervention group

Description:

The control arm will consist of 18 PGY-1 residents who are scheduled by the residency program's algorithm in the usual fashion to complete general medicine rotations on 5 difference clinical floors. The 18 active comparator participants will be selected based on completing one of four general medicine rotation on the control floor White 8. These participants will then be followed while completing the remaining general medicine rotations on all clinical floors.