A Qualitative Evaluation of Geographical Localization of Hospitalists: How Unintended Consequences May Impact Quality.
J Gen Intern Med. 2014 Feb 19;
Authors: Singh S, Fletcher KE
BACKGROUND: Geographical localization of hospitalist teams to nursing units may have an impact on the quality of inpatient care. The perceptions of individuals who provide patient care in a localized model of care have not been adequately studied.
OBJECTIVE: To determine the impact of geographic localization of hospitalist teams by evaluating the perceptions of hospitalists (faculty and physician assistants) localized to a single nursing unit and the nurses who staffed that unit.
DESIGN: Focus group study.
SUBJECTS: Six hospitalist faculty and three hospitalist physician assistants who provided patient care while localized to a single nursing unit, as well as 29 nurses who staffed the nursing unit where localization occurred.
MAIN MEASURES: Themes that emerged from grounded theory analysis of focus group transcripts.
KEY RESULTS: Participants perceived an overall positive impact of localization on the quality of patient care they provide and their workflow. The positive impact was mediated through proximity to patients and between members of the healthcare team, as well as through increased communication, decreased wasted time and increased teamwork. The participants also identified increased interruptions, variability in patient flow, mismatches in specialization and perverse incentives as mediating factors leading to unintended consequences. A model emerged that can inform future deployment and evaluation of localization interventions.
CONCLUSIONS: Geographical localization of hospitalist teams is perceived to be desirable by both hospitalists and nurses. Others who attempt localization could use our conceptual model as a guide to maximize the benefit and minimize the unintended consequences of this intervention.
PMID: 24549518 [PubMed - as supplied by publisher]