Abstract
BackgroundOur goal is to improve the safety and effectiveness of inpatient care. Rather than focus on improving process of care, we focus on the social structure within physician teams. We have developed the Physician Relationships, Improvising, and Sensemaking (PRISm) intervention to improve the way physician teams round, enabling them to better relate, make sense of their patients’ conditions, and improvise in uncertain clinical situations. We are currently studying the impact of PRISm on adverse events and complications in hospitalized patients. This manuscript describes the PRISm intervention.Methods/designPRISm is a structured communication tool consisting of three components: daily briefings before rounds; use of the Situation, Task, Intent, Concern, and Calibrate (STICC) framework during rounds as part of the discussion of individual patients; and debriefings after rounds. We are implementing the PRISm intervention on eight inpatient medical and surgical physician teams in the South Texas Veterans Health Care System. We are assessing PRISm impact on the way team members relate to each other, round, and discuss patients through pre- and post-implementation observations and surveys. We are also assessing PRISm impact on complications and adverse events. Finally, we are interviewing physicians regarding their experience using the intervention.DiscussionOur results will allow us to begin to understand the potential impact of interventions designed to improve how providers relate to each other, improvise, and make sense of what is happening as a strategy for improving inpatient care. Our in-depth data collection will enable us to assess how relationships, improvising, and sensemaking influence patient outcomes, potentially through creating shared mental models or enhancing distributed cognition during clinical reasoning. Finally, our results will lay the groundwork for larger implementation studies to improve clinical outcomes through improving how providers, and providers, patients, and caregivers, relate.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0171-3) contains supplementary material, which is available to authorized users.
Highlights
Our goal is to improve the safety and effectiveness of inpatient care
Our results will allow us to begin to understand the potential impact of interventions designed to improve how providers relate to each other, improvise, and make sense of what is happening as a strategy for improving inpatient care
An alternative approach for improving clinical systems is grounded in the framework of complexity science [8,9]
Summary
Our goal is to improve the safety and effectiveness of inpatient care. Rather than focus on improving process of care, we focus on the social structure within physician teams. We have developed the Physician Relationships, Improvising, and Sensemaking (PRISm) intervention to improve the way physician teams round, enabling them to better relate, make sense of their patients’ conditions, and improvise in uncertain clinical situations. To improve clinical system performance, we must improve providers’ ability to perform effectively in the face of uncertainty This may be true in inpatient environments, where patients are acutely ill, diagnoses are often uncertain, and the possibility of developing complications is significant. Studies of inpatient and outpatient teams suggest that relationships among providers have an important effect on patient outcomes. Physician team Relationships, Improvising, and Sensemaking have been associated with outcomes for hospitalized patients, including length of stay and complication rates. Its purpose is to improve patient outcomes by changing the ways that physicians communicate and improving their ability to make sense and improvise
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