Luci K Leykum1,2,3, Polly H Noël4,5, Lauren S Penney4,5, Michael Mader4, Holly J Lanham5, Erin P Finley5,6, Jacqueline A Pugh4,5. 1. South Texas Veterans Health Care System, San Antonio, TX, USA. Luci.Leykum@austin.utexas.edu. 2. University of Texas at Austin Dell Medical School, Austin, TX, USA. Luci.Leykum@austin.utexas.edu. 3. Audie L. Murphy VA Hospital, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA. Luci.Leykum@austin.utexas.edu. 4. South Texas Veterans Health Care System, San Antonio, TX, USA. 5. Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. 6. VA Greater Los Angeles Health Care System, Los Angeles, TX, USA.
Abstract
BACKGROUND: Interdisciplinary teams (IDTs) have been implemented to improve collaboration in hospital care, but their impact on patient outcomes, including readmissions, has been mixed. These mixed results might be rooted in differences in organization of IDT meetings between hospitals, as well as variation in IDT characteristics and function. We hypothesize that relationships between IDT members are an important team characteristic, influencing IDT function in terms of how members make sense of what is happening with patients, a process called sensemaking OBJECTIVE: (1) To describe how IDT meetings are organized in practice, (2) assess differences in IDT member relationships and sensemaking during patient discussions, and (3) explore their potential association with risk-stratified readmission rates (RSRRs). DESIGN: Observational, explanatory convergent mixed-methods case-comparison study of IDT meetings in 10 Veterans Affairs hospitals. PARTICIPANTS: Clinicians participating in IDTs and facility leadership. APPROACH: Three-person teams observed and recorded IDT meetings during week-long visits. We used observational data to characterize relationships and sensemaking during IDT patient discussions. To assess sensemaking, we used 2 frameworks that reflected sensemaking around each patient's situation generally, and around care transitions specifically. We examined the association between IDT relationships and sensemaking, and RSRRs. KEY RESULTS: We observed variability in IDT organization, characteristics, and function across 10 hospitals. This variability was greater between hospitals than between teams at the same hospital. Relationship characteristics and both types of sensemaking were all significantly, positively correlated. General sensemaking regarding each patient was significantly negatively associated with RSRR (- 0.65, p = 0.044). CONCLUSIONS: IDTs vary not only in how they are organized, but also in team relationships and sensemaking. Though our design does not allow for inferences of causation, these differences may be associated with hospital readmission rates.
BACKGROUND: Interdisciplinary teams (IDTs) have been implemented to improve collaboration in hospital care, but their impact on patient outcomes, including readmissions, has been mixed. These mixed results might be rooted in differences in organization of IDT meetings between hospitals, as well as variation in IDT characteristics and function. We hypothesize that relationships between IDT members are an important team characteristic, influencing IDT function in terms of how members make sense of what is happening with patients, a process called sensemaking OBJECTIVE: (1) To describe how IDT meetings are organized in practice, (2) assess differences in IDT member relationships and sensemaking during patient discussions, and (3) explore their potential association with risk-stratified readmission rates (RSRRs). DESIGN: Observational, explanatory convergent mixed-methods case-comparison study of IDT meetings in 10 Veterans Affairs hospitals. PARTICIPANTS: Clinicians participating in IDTs and facility leadership. APPROACH: Three-person teams observed and recorded IDT meetings during week-long visits. We used observational data to characterize relationships and sensemaking during IDT patient discussions. To assess sensemaking, we used 2 frameworks that reflected sensemaking around each patient's situation generally, and around care transitions specifically. We examined the association between IDT relationships and sensemaking, and RSRRs. KEY RESULTS: We observed variability in IDT organization, characteristics, and function across 10 hospitals. This variability was greater between hospitals than between teams at the same hospital. Relationship characteristics and both types of sensemaking were all significantly, positively correlated. General sensemaking regarding each patient was significantly negatively associated with RSRR (- 0.65, p = 0.044). CONCLUSIONS: IDTs vary not only in how they are organized, but also in team relationships and sensemaking. Though our design does not allow for inferences of causation, these differences may be associated with hospital readmission rates.
Authors: Holly J Lanham; Reuben R McDaniel; Benjamin F Crabtree; William L Miller; Kurt C Stange; Alfred F Tallia; Paula Nutting Journal: Jt Comm J Qual Patient Saf Date: 2009-09
Authors: Luci K Leykum; Holly J Lanham; Jacqueline A Pugh; Michael Parchman; Ruth A Anderson; Benjamin F Crabtree; Paul A Nutting; William L Miller; Kurt C Stange; Reuben R McDaniel Journal: Implement Sci Date: 2014-11-19 Impact factor: 7.327
Authors: Lauren S Penney; Luci K Leykum; Polly Noël; Erin P Finley; Holly Jordan Lanham; Jacqueline Pugh Journal: BMJ Open Date: 2018-04-07 Impact factor: 2.692
Authors: Jacqueline Pugh; Lauren S Penney; Polly H Noël; Sean Neller; Michael Mader; Erin P Finley; Holly J Lanham; Luci Leykum Journal: BMC Health Serv Res Date: 2021-03-01 Impact factor: 2.655