***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Previous studies found that medication errors result from lack of sufficient information during the prescribing step . Therefore , it is proposed that having a pharmacist available when patients are evaluated during the rounding process may reduce the likelihood of preventable adverse drug events ( ADEs ) . The objectives of this study were to evaluate the impact of having a pharmacist participate with a physician rounding team on preventable ADEs in general medicine units and to document pharmacist interventions made during the rounding process . METHODS A single-blind , st and ard care-controlled study design was used to compare  patients receiving care from a rounding team including a pharmacist with patients receiving st and ard care ( no pharmacist on rounding team ) . Patients admitted to and discharged from the same general medicine unit were included in the study . The main outcome measure of this study was preventable ADEs . Patient records were r and omly selected and evaluated by a blinded process involving independent senior pharmacist specialists and a senior staff physician . Interventions made by the pharmacists in the treatment group were documented . RESULTS The rate of preventable ADEs was reduced by 78 % , from 26.5 per 1000 hospital days to 5.7 per 1000 hospital days . There were 150 documented interventions recommended during the rounding process , 147 of which were accepted by the team . The most common interventions were ( 1 ) dosing-related changes and ( 2 ) recommendations to add a drug to therapy . CONCLUSION Pharmacist participation with the medical rounding team on a general medicine unit contributes to a significant reduction in preventable ADEs BACKGROUND Acute hospital general medicine services care for ageing complex patients , using the skills of a range of health-care providers . Evidence suggests that comprehensive early assessment and discharge planning may improve efficiency and outcomes of care in older medical patients . AIM To enhance assessment , communication , care and discharge planning by restructuring consistent , patient-centred multidisciplinary teams in a general medicine service . METHODS Prospect i ve controlled trial enrolling 1538 consecutive medical in patients . Intervention units with additional allied health staff formed consistent multidisciplinary teams aligned with inpatient admitting units rather than wards ; implemented improved communication processes for early information collection and sharing between disciplines ; and specified shared explicit discharge goals . Control units continued traditional , referral-based multidisciplinary models with existing staffing levels . RESULTS Access to allied health services was significantly enhanced . There was a trend to reduced index length of stay in the intervention units ( 7.3 days vs 7.8 days in control units , P = 0.18 ) , with no change in 6-month readmissions . In-hospital mortality was reduced from 6.4 to 3.9 % ( P = 0.03 ) ; less patients experienced functional decline in hospital ( P = 0.04 ) and patients ' ratings of health status improved ( P = 0.02 ) . Additional staffing costs were balanced by potential bed-day savings . CONCLUSION This model of enhanced multidisciplinary inpatient care has provided sustainable efficiency gains for the hospital and improved patient outcomes OBJECTIVES In August 1993 a group of house staff and nursing staff at MetroHealth Medical Center formed a quality improvement team to evaluate the process of medical care on the inpatient wards . Using st and ard continuous quality improvement ( CQI ) methods , a team of medical interns , nurses , and other health professionals involved in patient care on the medicine inpatient service design ed interdisciplinary , daily work rounds to improve the care of patients on the inpatient wards . METHODS The authors conducted a r and omized , controlled firm trial of the impact of interdisciplinary rounds on the inpatient medicine services . The trial lasted 6 months ( November 1993-April 1994 ) and included 1,102 admissions r and omly assigned to experimental or control teams by the pre-existing firm system . Of the 1,102 admissions included in the study , 535 were r and omized to medical services with traditional rounds and 567 to medical services with interdisciplinary rounds .  The outcomes studied included length of stay ( LOS ) , total hospital charges , provider satisfaction , and ancillary service efficiency . RESULTS Unadjusted analysis for log-transformed data showed lower length of stay and total charges for the interdisciplinary group . The mean LOS for interdisciplinary rounds was 5.46 days , compared with 6.06 days for traditional care ( P = 0.006 ) , whereas mean total charges were $ 6,681 and $ 8,090 ( P = 0.002 ) for the two groups , respectively . After multivariate regression analysis using a propensity score that included gender , age , marital status , admission source , diagnosis-related group ( DRG ) weight , and primary diagnosis by International Classification of Diseases , Ninth Revision ( ICD-9 ) cluster , these differences remained statistically significant . CONCLUSIONS Previous studies of interdisciplinary teams have failed to show statistically significant cost savings . This study involving more patients shows both cost and LOS decreases with the use of interdisciplinary teams . At the end of the 6-month trial , interdisciplinary rounds were instituted on all medicine inpatient services BACKGROUND Effective collaboration and teamwork is essential to providing safe hospital care . The objective of this study was to assess the effect of an intervention design ed to improve interdisciplinary collaboration and lower the rate of adverse events ( AEs ) . METHODS The study was a controlled trial of an intervention , Structured Inter-Disciplinary Rounds , implemented in 1 of 2 similar medical teaching units in a tertiary care academic hospital . The intervention combined a structured format for communication with a forum for regular interdisciplinary meetings . We conducted a retrospective medical record review evaluating 370 r and omly selected patients admitted to the intervention and control units ( n = 185 each ) in the 24 weeks after and 185 admitted to the intervention unit in the 24 weeks before the implementation of Structured Inter-Disciplinary Rounds ( N = 555 ) . Medical records were screened for AEs . Two hospitalists confirmed the presence of AEs and assessed their preventability and severity in a masked fashion . We used multivariable Poisson regression models to compare the adjusted incidence of AEs in the intervention unit to that in concurrent and historic control units . RESULTS The rate of AEs was 3.9 per 100 patient-days for the intervention unit compared with 7.2 and 7.7 per 100 patient-days , respectively , for the concurrent and historic control units ( adjusted rate ratio , 0.54 ; P = .005 ; and 0.51 ; P = .001 ) . The rate of preventable AEs was 0.9 per 100 patient-days for the intervention unit compared with 2.8 and 2.1 per 100 patient-days for the concurrent and historic control units ( adjusted rate ratio , 0.27 ; P = .002 ; and 0.37 ; P = .02 ) . The low number of AEs rated as serious or life-threatening precluded statistical analysis for differences in rates of events classified as serious or serious and preventable . CONCLUSION Structured Inter-Disciplinary Rounds significantly reduced the adjusted rate of AEs in a medical teaching unit PROBLEM Teaching hospital multidisciplinary work rounds are often inefficient , delaying the completion of patient care tasks and detracting from teaching . Participants often act as working groups rather than interdependent teams . Athletic principles were used to train multidisciplinary rounding teams to adopt the systems used by manufacturing to improve the efficiency and quality of patient care , as well as teamwork and didactic teaching . APPROACH Experimental groups of general medical rounding teams-faculty member , house staff , medical students , bedside nurses , pharmacists , and a case manager-were introduced to individual job descriptions ( playbooks ) , key customer-supplier relation ships , and efficient communication protocol s , accompanied by weekly feed back ( game films ) . A two-phase pilot 11-month prospect i ve trial ( February to July 2009 and September 2011 to January 2012 ) compared the experimental and control rounding teams on the basis of length of stay , 30-day readmission rates , and physician , student , and patient satisfaction . OUTCOMES These interventions result ed in a 30 % reduction in 30-day readmissions and , in the 2011 - 2012 phase , an 18 % shorter length of stay . Anonymous surveys documented greater satisfaction of faculty , residents , and medical students , and student ratings of teaching were markedly improved . Patient satisfaction did not change . NEXT STEPS The new rounding system has the potential to reduce waste and improve the quality of patient care while improving caregiver satisfaction and medical student teaching . Adaptive leadership skills will be required to overcome resistance to change . The use of athletic analogies can improve teamwork and facilitate the adoption of a systems approach to the delivery of patient care OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Background : Medical in patients are at risk for suboptimal health outcomes from adverse drug events and under-use of evidence -based therapies . We sought to determine whether collaborative care including a team-based clinical pharmacist improves the quality of prescribed drug therapy and reduces hospital readmission . Methods : Multicenter , quasi-r and omized , controlled clinical trial . Consecutive patients admitted to 2 internal and 2 family medicine teams in 3 teaching hospitals between January 30 , 2006 and February 2 , 2007 were included . Team care patients received proactive clinical pharmacist services ( medication history , patient-care round participation , resolution of drug-related issues , and discharge counseling ) . Usual care patients received traditional reactive clinical pharmacist services . The primary outcome was the overall quality score measured retrospectively by a blinded chart review er using 20 indicators targeting 5 conditions . Secondary outcomes included 3- and 6-month readmission . Results : A total of 452 patients ( 220 team care , 231 usual care , mean age : 74 years , 46 % male ) met eligibility criteria . Team care patients were more likely than usual care patients to receive care specified by the indicators overall ( 56.4 % vs. 45.3 % ; adjusted mean difference : 10.4 % ; 95 % confidence interval [ CI ] : 4.9 % , 15.7 % ) and for each targeted disease state except for heart failure . Team care patients experienced fewer readmissions at 3 months ( 36.2 % vs. 45.5 % ; adjusted OR : 0.63 ; 95 % CI : 0.42 , 0.94 ) but not at 6 months ( 50.7 % vs. 56.3 % ; adjusted OR ; 0.78 ; 95 % CI : 0.53 , 1.15 ) . Conclusions : In patients admitted to internal and family medicine teams , team-based care including a clinical pharmacist , improved the overall quality of medication use and reduced rates of readmission The financial impact of pharmacist participation on a medical team in a tertiary-care teaching hospital was studied prospect ively . Two medical teams , one with and one without a pharmacist , operated simultaneously for 11 months . Physicians and a pharmacist  on the teams rotated monthly during the first five months of the study . Subsequently , the hospital administrator , who was unaware that the controlled study was under way , permanently assigned an attending physician to the team that did ot have a pharmacist . After patients ' discharge , pharmacy costs , pharmacy charges , hospital charges , and length of stay ( LOS ) were compared for the two teams . Data analysis was separated into four phases : phase 1 , during which attending physicians rotated monthly ; phase 2 , with a permanent attending physician ; phase 3 , which encompassed the entire 11 months ; and phase 4 , which encompassed the 11-month period but omitted patients whose LOS exceeded 30 days . 
    Output:
    
There are reasonable data to support an association with length of stay and staff satisfaction but little data on patient safety or satisfaction .
Positive outcomes may be related to particular components of IDR design , but the relationship between design and outcomes remains unclear .