***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: Objective : To compare nurse practitioner/physician management of hospital care , multidisciplinary team-based planning , expedited discharge , and assessment after discharge to usual management . Background : In the context of managed care , the goal of academic medical centers is to provide quality care at the lowest cost and minimize length of stay ( LOS ) while not compromising quality . Methods : Comparative , 2-group , quasiexperimental design was used ; 1,207 general medicine patients ( n = 581 in the experimental group and n = 626 in the control group ) were enrolled . The control unit provided usual care . The care management in the experimental unit had 3 different components : an advanced practice nurse who followed the patients during hospitalization and 30 days after discharge , a hospitalist medical director and another hospitalist , and daily multidisciplinary rounds .  LOS , hospital costs , mortality , and readmission 4 months after discharge were measured . Results : Average LOS was significantly lower for patients in the experimental group than the control group ( 5 vs. 6 days , P < .0001 ) . The " backfill profit " to the hospital was US$ 1591 per patient in the experimental group ( SE , US$ 639 ) . There were no significant group differences in mortality or readmissions . Conclusions : Collaborative physician/nurse practitioner multidisciplinary care management of hospitalized medical patients reduced LOS and improved hospital profit without altering readmissions or mortality 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 : Nosocomial infections occur in approximately 10 % of patients in intensive care units ( ICUs ) . Several studies have shown that a quality improvement initiative can reduce nosocomial infections , mortality , and cost . Context : Our hospital is located in Northern Mississippi and has a 28 bed Medical-Surgical ICU unit with 95 % occupancy . We joined the ICU collaborative with the IMPACT initiative of the Institute of Healthcare Improvement ( IHI ) in October 2002 . A preliminary prospect i ve before ( fiscal year ( FY ) 2001–2 ) and after ( FY 2003 ) hypothesis generating study was conducted of outcomes result ing from small tests of change in the management of ICU patients . Key measures for improvement : Nosocomial infection rates , adverse events per ICU day , average length of stay , and average cost per ICU episode . Strategy for change : Four changes were implemented : ( 1 ) physician led multidisciplinary rounds ; ( 2 ) daily “ flow ” meeting to assess bed availability ; ( 3 ) “ bundles ” ( sets of evidence based best practice s ) ; and ( 4 ) culture changes with a focus on the team decision making process . Effects of change : Between baseline and re-measurement periods , nosocomial infection rates declined for ventilator associated pneumonia ( from 7.5 to 3.2 per 1000 ventilator days , p = 0.04 ) and bloodstream infections ( from 5.9 to 3.1 per 1000 line days , p = 0.03 ) , with a downward trend in the rate of urinary tract infections ( from 3.8 to 2.4 per 1000 catheter days , p = 0.17 ) . There was a strong downward trend in the rates of adverse events in the ICU as well as the average length of stay per episode . From FY 2002 to FY 2003 the cost per ICU episode fell from $ 3406 to $ 2973 . Lessons learned : A systematic approach through collaboration with IHI ’s IMPACT initiative may have contributed to significant improvements in care in the ICU setting . Multidisciplinary teams appeared to improve communication , and bundles provided consistency of evidence based practice s. The flow meetings allowed for rapid prioritization of activity and a new decision making culture empowered team members . The impact of these changes needs to be assessed more widely using rigorous study design 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 Objectives : To determine whether face-to-face prompting of critical care physicians reduces empirical antibiotic utilization compared to an unprompted electronic checklist embedded within the electronic health record . Design : R and om allocation design . Setting : Medical ICU with high-intensity intensivist coverage at a tertiary care urban medical center . Patients : Two hundred ninety-six critically ill patients treated with at least 1 day of empirical antibiotics . Interventions : For one medical ICU team , face-to-face prompting of critical care physicians if they did not address empirical antibiotic utilization during a patient ’s daily rounds . On a separate medical ICU team , attendings and fellows were trained once to complete an electronic health record-embedded checklist daily for each patient , including a question asking whether listed empirical antibiotics could be discontinued . Measurements and Main Results : Prompting led to a more than four-fold increase in discontinuing or narrowing of empirical antibiotics compared to use of the electronic checklist . Prompted group patients had a lower proportion of patient-days on which empirical antibiotics were administered compared to electronic checklist group patients ( 63.1 % vs 70.0 % , p = 0.002 ) . Mean proportion of antibiotic-days on which empirical antibiotics were used was also lower in the prompted group , although not statistically significant ( 0.78 [ 0.27 ] vs 0.83 [ 0.27 ] , p = 0.093 ) . Each additional day of empirical antibiotics predicted higher risk-adjusted mortality ( odds ratio , 1.14 ; 95 % CI , 1.05–1.23 ) . Risk-adjusted ICU length of stay and hospital mortality were not significantly different between the two groups . Conclusions : Face-to-face prompting was superior to an unprompted electronic health record-based checklist at reducing empirical antibiotic utilization . Sustained culture change may have contributed to the electronic checklist having similar empirical antibiotic utilization to a prompted group in the same medical ICU 2 years prior . Future studies should investigate the integration of an automated prompting mechanism with a more generalizable electronic health record-based checklist Purpose To describe how communication failures contribute to many medical mishaps . Method In late 1999 , a sample of 26 residents stratified by medical specialty , year of residency , and gender was r and omly selected from a population of 85 residents at a 600-bed U.S. teaching hospital . The study design involved semistructured face-to-face interviews with the residents about their routine work environments and activities , the medical mishaps in which they recently had been involved , and a description of both the individual and organizational contributory factors . The themes reported here emerged from inductive analyses of the data . Results Residents reported a total of 70 mishap incidents . Aspects of “ communication ” and “ patient management ” were the two most commonly cited contributing factors . Residents described themselves as embedded in a complex network of relationships , playing a pivotal role in patient management vis-à-vis other medical staff and health care providers from within the hospital and from the community . Recurring patterns of communication difficulties occur within these relationships and appear to be associated with the occurrence of medical mishaps . Conclusion The occurrence of everyday medical mishaps in this study is associated with faulty communication ; but , poor communication is not simply the result of poor transmission or exchange of information . Communication failures are far more complex and relate to hierarchical differences , concerns with upward influence , conflicting roles and role ambiguity , and interpersonal power and conflict . A clearer underst and ing of these dynamics highlights possibilities for appropriate interventions in medical education and in health care organizations aim ed at improving patient safety PURPOSE Establishing well-understood daily patient care goals should improve healthcare team ( HCT ) communication , reduce errors , and improve patient outcomes . The purpose of this study was to test the hypothesis that implementation of a daily goals " Door Communication Card " ( DCC ) would improve goal alignment between members of the HCT . METHODS As part of a process improvement project , HCT members listed their top care goals for a patient on a given day . After initial data collection , DCCs were placed on patients ' doors . Anyone was allowed to write on the card , but the " official " daily goals were recorded during multidisciplinary rounds . One month after introduction of the DCC , HCT members were re-queried about their patients ' care goals . Three review ers independently compared goals and assessed their alignment before and after implementation of the DCC . We collected goals over a 4-month period and selected 5 r and om days before and after intervention for assessment . RESULTS The goal alignment among HCT members was low before and did not improve after intervention ( Attending-to-Nurse 55 % vs 38 % , P = .02 ; Attending-to-Resident 60 % vs 54 % , P = .43 ; Attending-to- Primary 35 % vs 28 % , P = .45 ; Nurse-to-Attending 52 % vs 36 % , P = .03 ; Nurse-to-Resident 55 % vs 38 % , P = .04 ; Nurse-to- Primary 37 % vs 27 % , P = .36 ; Resident-to-Attending 59 % vs 54 % , P = .4 ; Resident-to-Nurse 56 % vs 40 % , P = .05 ; Resident-to- Primary 36 % vs 24 % , P = .16 ; Primary -to-Attending 34 % vs 42 % , P = .44 ; Primary -to-Nurse 42 % vs 35 % , P = .6 ; Primary -to-Resident 32 % vs 34 % , P = .8 ) . CONCLUSIONS Alignment of daily patient care goals among HCT members is low overall and did not improve after implementing a DCC available to all team members . Further study to eluci date the mechanism by which daily goals forms improve patient care is required BACKGROUND Clear communication is imperative if teams in any industry expect to make improvements . An estimated 85 % of errors across industries result from communication failures . PURPOSE The purpose of this study was to evaluate and improve the effectiveness of communication  during patient care rounds in the intensive care unit ( ICU ) using a daily goals form . DESIGN We conducted a prospect i ve cohort study in collaboration with the Volunteer Hospital Association ( VHA ) , Institute for Healthcare Improvement ( IHI ) , and Johns Hopkins Hospital 's ( JHH ) 16-bed surgical oncology ICU . All patients admitted to the ICU were el 
    Output:
    
The evidence suggests that MDR utilizing a structured communication tool may have contributed to an improvement in staff satisfaction .
There was inconclusive evidence to support the use of structured MDR to improve LOS or patient satisfaction .
The use of a structured communication tool during MDR is one means to facilitate communication and collaboration , thus improving satisfaction among the multidisciplinary team .