Effect of a Multidisciplinary Intervention on Communication and Collaboration Among Physicians and Nurses

Sondra Vazirani, MD, MPH; Ron D. Hays, PhD; Martin F. Shapiro, MD, PhD; Marie Cowan, RN, PhD

Disclosures

Am J Crit Care. 2005;14(1):71-77. 

In This Article

Abstract and Introduction

Background: Improving communication and collaboration among doctors and nurses can improve satisfaction among participants and improve patients' satisfaction and quality of care.
Objective: To determine the impact of a multidisciplinary intervention on communication and collaboration among doctors and nurses on an acute inpatient medical unit.
Methods: During a 2-year period, an intervention unit was created that differed from the control unit by the addition of a nurse practitioner to each inpatient medical team, the appointment of a hospitalist medical director, and the institution of daily multidisciplinary rounds. Surveys about communication and collaboration were administered to personnel in both units. Physicians were surveyed at the completion of each rotation on the unit; nurses, biannually.
Results: Response rates for house staff (n = 111), attending physicians (n = 45), and nurses (n = 123) were 58%, 69%, and 91%, respectively. Physicians in the intervention group reported greater collaboration with nurses than did physicians in the control group (P < .001); the largest effect was among the residents. Physicians in the intervention group reported better collaboration with the nurse practitioners than with the staff nurses (P < .001). Physicians in the intervention group also reported better communication with fellow physicians than did physicians in the control group (P = .006). Nurses in both groups reported similar levels of communication (P = .59) and collaboration (P = .47) with physicians. Nurses in the intervention group reported better communication with nurse practitioners than with physicians (P < .001).
Conclusions: The multidisciplinary intervention resulted in better communication and collaboration among the participants.

Collaboration has been defined as an interaction between doctor and nurse that "enable[s] the knowledge and skills of both professionals to synergistically influence the patient care being provided."[1] The results of the demonstration project of the National Joint Practice Commission with subjective interview data in the late 1970s suggested that interventions that foster nurse-physician collaboration improve the satisfaction of doctors, nurses, and patients.[2] At the completion of the project, improved quality of care and reduced costs to the institution were also reported.[3] Later, the interventions from the study were duplicated with a control unit, with similar results.[4]

Despite these findings, literature that describes controlled interventions to improve the relationship between doctors and nurses is sparse. The Cochrane Database includes a search for randomized trials that designed interventions to improve doctor-nurse collaboration[5]; only one such study[6] had been done in the United States. In that study,[6] the primary aim was to improve patients' care by creating daily interdisciplinary rounds, and the main outcome measured was resource utilization. Additionally, the instruments used in the study surveys were not tested or validated as measures of providers' satisfaction, and the results were not separated according to the type of provider.

The Multidisciplinary Doctor Nurse Practitioner Study was designed to compare the effectiveness of care management with a multidisciplinary team with the effectiveness of a conventional approach for acutely ill general medicine inpatients on the basis of organizational and patients' outcomes. In this article, we describe changes in communication and collaboration between physicians and nurses associated with the study. We hypothesized that the structure of the intervention would promote improved communication and collaboration between healthcare providers.

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