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Completed

NCT Number: NCT05213117

Optimizing Medical "Teaming" on Resident Based Teams

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.

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Key information

Conditions

Inter-professional Relations

Age range

24 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Massachusetts General Hospital

Boston, Massachusetts, 02114, United States

About this study

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.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

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

Exclusion criteria

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

Treatment and study plan

Co-Localization with Nursing

Behavioral

Co-localize 15 residents to one of 6 general medical floors to complete all 8 weeks of general medicine on this floor

Primary outcomes

  1. Teamwork assessed by Simulation about Shortness of Breath

    Time frame: This simulation will be conducted at 6 months in this 12month study

    Simulation of an inpatient clinical scenario will be conducted. This simulation about shortness of breath will be run with teams consisting of two residents and two nurses. These interdisciplinary teams will be asked to manage a patient together. All residents and nurses in the study will be asked to participate in the simulation. The simulations will be recorded. Blinded reviewers will view these simulations later and will score the team's performance using an published Oxford NOTECH simulation teamwork assessment tool. The assessment tool is designed to identify higher functioning teams by evaluating leadership, communication, shared mental models and utilization of resources.

  2. Teamwork assessed by Simulation about Negotiation with Angry Patient

    Time frame: This simulation will be conducted at 12 months in this 12month study

    Simulation of an inpatient clinical scenario will be conducted. This simulation about negotiating with an angry patient will be run with teams consisting of two residents and two nurses. These interdisciplinary teams will be asked to manage a patient together. All residents and nurses in the study will be asked to participate in the simulation. The simulations will be recorded. Blinded reviewers will view these simulations later and will score the team's performance using an published Oxford NOTECH simulation teamwork assessment tool. The assessment tool is designed to identify higher functioning teams by evaluating leadership, communication, shared mental models and utilization of resources.

Secondary outcomes

  1. Psychological Safety

    Time frame: Residents and Nurses will be surveyed at 6 months in this 12 month study

    A survey tool has been developed for both residents and nurses. The survey tool asks questions using a 5 point Likert scale about psychological safety, communication and teamwork. The questions were modified based on prior published work by Dr. Amy Edmondson at the Harvard Business School. The survey will be used to evaluate the residents and nurses perception of teamwork and psychological safety.

  2. Psychological Safety

    Time frame: Residents and Nurses will be surveyed at 12 months in this 12 month study

    A survey tool has been developed for both residents and nurses. The survey tool asks questions using a 5 point Likert scale about psychological safety, communication and teamwork. The questions were modified based on prior published work by Dr. Amy Edmondson at the Harvard Business School. The survey will be used to evaluate the residents and nurses perception of teamwork and psychological safety.

  3. Communication between Nurses and Interns

    Time frame: Observation will start at 6 months in this 12 month study and continue through study completion, an average of 6 months

    A time motion study will be conducted where an observer with an Apple iPad will observe rounds with nurses and interns. The observer will record the amount of time each individual is speaking, the length of rounds and the number of patients rounded on.

Sponsors and collaborators

Lead sponsor

Massachusetts General Hospital

Other

Registry information

Important dates

Study start
2019
Primary completion
2020
Study completion
2021
First posted
Jan 28, 2022
Registry last updated
Jan 28, 2022

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.