Interprofessional Collaborative Communication in Acute Care Hospital Teams

The SCRIPT Programme (GIM): Structuring Communication Relationships for Interprofessional Teamwork to Achieve Interprofessional Education for Collaborative Patient-Centered Practice (IECPCP)

Collaborative practice may improve patient outcomes in specific disease conditions and health care settings. The SCRIPT Programme is an intervention to implement informal, but structured, communication etiquette between members of interprofessional ward-based clinical teaching units (CTUs) in General Internal Medicine (GIM) hospital divisions.

A recent literature review commissioned by Health Canada for the Inter-Professional Education for Collaborative Patient-Centred Practice initiative (IECPCP) reported evidence that collaborative practice improves patient outcomes in specific populations. Interprofessional collaborative teaching and practicing are poorly articulated in the literature, however. Studies are needed that can develop a trial-based body of evidence to support education and practice of effective interprofessional care.

The SCRIPT project will attempt to develop sustainable transformation in the conduct, learning and evaluation of interprofessional teamwork in the Toronto Academic Health Science Network (TAHSN). SCRIPT has investigated interprofessional work relations in general internal medicine units at TAHSN hospitals using fieldwork observations and interview methods. These data were foundational for SCRIPT's design of a unit-based staff intervention intended to promote more--and more-effective--informal interprofessional communication and collaboration between GIM staff members outside of traditional, structured meeting times like morning report and bullet rounds.

The intervention is designed as part of a pragmatic trial. We will ask GIM division staff of intervention teams to implement a 4-step communication protocol in face-to-face, patient-related interaction. The steps are:

1. introduce oneself by name;
2. state one's role or responsibility in relation to the patient under discussion;
3. describe the issue, problem, or plan relating to the target patient;
4. elicit feedback from the other participant(s) in the interaction with a prompt, e.g., "do you have any concerns," or, "is there something else I should consider?"

The intervention will be evaluated as a cluster randomized controlled trial among five large Toronto (Canada) teaching hospitals. Two medical clinical teaching units and associated ward teams of nurses and other health professionals from each hospital's GIM division will be allocated at random to enact the intervention. Two other GIM CTUs in each hospital will continue their usual interprofessional practice, without intervention. In total, there are 20 CTUs, 10 in the treatment group and 10 in the control group. Intervention CTUs will be compared with control CTUs on the outcomes of interest.

Inclusion Criteria:

• Patients admitted to divisions of General Internal Medicine
• Health care providers working in divisions of General Internal Medicine