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Effects of a multicentre teamwork and communication programme on patient outcomes: results from the Triad for Optimal Patient Safety (TOPS) project
  1. Andrew D Auerbach1,
  2. Niraj L Sehgal1,
  3. Mary A Blegen2,
  4. Judith Maselli1,
  5. Brian K Alldredge3,
  6. Eric Vittinghoff4,
  7. Robert M Wachter1
  1. 1Division of Hospital Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
  2. 2Center for Patient Safety, University of California, San Francisco School of Nursing, San Francisco, California, USA
  3. 3University of California, San Francisco School of Pharmacy, San Francisco, California, USA
  4. 4Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
  1. Correspondence to Dr Andrew D Auerbach, UCSF Department of Medicine Hospitalist Group, 505 Parnassus Avenue, Box 0131, San Francisco, CA 94143-0131, USA; ada{at}


Background Improving communication between caregivers is an important approach to improving safety.

Objective To implement teamwork and communication interventions and evaluate their impact on patient outcomes.

Design A prospective, interrupted time series of a three-phase intervention: a run-in period (phase 1), during which a training programme was given to providers and staff on each unit; phase 2, which focused on unit-based safety teams to identify and address care problems using skills from phase 1; and phase 3, which focused on engaging patients in communication efforts.

Setting General medical inpatient units at three northern California hospitals.

Patients Administrative data were collected from all adults admitted to the target units, and a convenience sample of patients interviewed during and after hospitalisation.

Measurements Readmission, length of stay and patient reports of teamwork, problems with care, and overall satisfaction.

Results 10 977 patients were admitted; 581 patients (5.3% of total sample) were interviewed in hospital, and 313 (2.9% overall, 53.8% of interviewed patients) completed 1-month surveys. No phase of the study was associated with adjusted differences in readmission or length of stay. The phase 2 intervention appeared to be associated with improvement in reports of whether physicians treated them with respect, whether nurses treated them with respect or understood their needs (p<0.05 for all). Interestingly, patients were more likely to perceive that an error took place with their care and agreed less that their caregivers worked well together as a team. No phase had a consistent impact on patient reports of care processes or overall satisfaction.

Limitations The study lacks direct measures of patient safety.

Conclusions Efforts to simultaneously improve caregivers' ability to troubleshoot care and enhance communication may improve patients' perception of team functions, but may also increase patients' perception of safety gaps.

  • Quality improvement methodologies
  • quality measurement
  • health services research
  • patient safety
  • incident reporting
  • healthcare quality improvement
  • hospital medicine
  • quality improvement
  • health policy

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  • Funding The TOPS project was funded by the Gordon and Betty Moore Foundation (Award #706). Dr Auerbach was supported by a K08 Patient Safety Research and Training Grant (K08 HS11416-02) from the Agency for Healthcare Research and Quality during the execution of this project. The funders had no role in the analysis of the data or drafting of this manuscript. Dr Auerbach had full access to study data and takes responsibility for the integrity of the data and accuracy of the data analysis.

  • Competing interests Dr Wachter reports having an equity interest and/or serving on paid advisory boards for PatientSafe Solutions and Epocrates; receiving honoraria from the American Board of Internal Medicine for serving on its board of directors and Executive Committee; receiving honoraria for many speeches on patient safety and quality; receiving funding under a contract from the Agency for Healthcare Research and Quality for editing two patient safety websites; and receiving royalties and honoraria from publishers for writing two books on patient safety and a blog. Dr Auerbach reports having received honoraria from the American Board of Internal Medicine for serving on an exam question-writing committee.

  • Patient consent Consent was waived per our IRB approval.

  • Ethics approval UCSF Committee on Human Research.

  • Provenance and peer review Not commissioned; externally peer reviewed.