Use of Unit-Based Interventions to Improve the Quality of Care for Hospitalized Medical Patients: A National Survey

Abstract

Background: Recent publications have drawn attention to interventions to redesign aspects of care delivery for hospitalized medical patients, including localization of physicians to specific units, nurse-physician co-leadership, interdisciplinary rounds (IDR), and access to quality performance data. Use of these interventions across hospitals has not been previously described.

Methods: A cross-sectional survey of internal medicine (IM) residency program directors and hospital medicine group (HMG) leaders in the United States was conducted to characterize use of unit-based interventions on inpatient medical services. The survey served as a pilot study to assess the use of localization of physicians to specific units, nurse-physician co-leadership, IDR, and access to quality performance data.

Results: Ninety-four IM program directors (response rate, 23.3%) and 62 HMG leaders (response rate, 20.7%) responded. No single intervention was used by the vast majority of sites, and the extent and intensity of use varied. About a quarter of respondents indicated that physicians typically cared for patients on only one to two units, a third or fewer had unit co-leadership on at least half of hospital units, fewer than half had daily IDR, and approximately half had access to unit-level performance data. Most IM programs and hospitalist groups had implemented 0 to 1 interventions to a high degree of fidelity, and few (≤ 5%) had implemented all 4.

Conclusion: IM program directors and HMG leaders reported variation in use of unit-based interventions to improve quality of care for medical inpatients. Future research should evaluate the association of the degree and intensity of using unit-based interventions on patient outcomes.