A Controlled Investigation of Optimal Internal Medicine Ward Team Structure at a Teaching Hospital

BACKGROUND: The optimal structure of an internal medicine ward team at a teaching hospital is unknown. We hypothesized that increasing the ratio of attendings to housestaff would result in an enhanced perceived educational experience for residents. METHODS: Harbor-UCLA Medical Center (HUMC) is a tertiary care, public hospital in Los Angeles County. Standard ward teams at HUMC, with a housestaff∶attending ratio of 5:1, were split by adding one attending and then dividing the teams into two experimental teams containing ratios of 3:1 and 2:1. Web-based Likert satisfaction surveys were completed by housestaff and attending physicians on the experimental and control teams at the end of their rotations, and objective healthcare outcomes (e.g., length of stay, hospital readmission, mortality) were compared. RESULTS: Nine hundred and ninety patients were admitted to the standard control teams and 184 were admitted to the experimental teams (81 to the one-intern team and 103 to the two-intern team). Patients admitted to the experimental and control teams had similar age and disease severity. Residents and attending physicians consistently indicated that the quality of the educational experience, time spent teaching, time devoted to patient care, and quality of life were superior on the experimental teams. Objective healthcare outcomes did not differ between experimental and control teams. CONCLUSIONS: Altering internal medicine ward team structure to reduce the ratio of housestaff to attending physicians improved the perceived educational experience without altering objective healthcare outcomes

Disseminated melioidosis in a patient from Nicaragua

Melioidosis is a disease caused by Burkholderia pseudomallei. Highly endemic areas include tropical Australia and Southeast Asia, though cases have been reported in the Americas. To our knowledge this is the first case to have occurred due to presumed exposure in Nicaragua, demonstrating the need for increased awareness. In addition, the severity of melioidosis also varies widely and more research is needed on the pattern of disease particularly in non-endemic regions

A controlled investigation of optimal internal medicine ward team structure at a teaching hospital.

BackgroundThe optimal structure of an internal medicine ward team at a teaching hospital is unknown. We hypothesized that increasing the ratio of attendings to housestaff would result in an enhanced perceived educational experience for residents.MethodsHarbor-UCLA Medical Center (HUMC) is a tertiary care, public hospital in Los Angeles County. Standard ward teams at HUMC, with a housestaff∶attending ratio of 5:1, were split by adding one attending and then dividing the teams into two experimental teams containing ratios of 3:1 and 2:1. Web-based Likert satisfaction surveys were completed by housestaff and attending physicians on the experimental and control teams at the end of their rotations, and objective healthcare outcomes (e.g., length of stay, hospital readmission, mortality) were compared.ResultsNine hundred and ninety patients were admitted to the standard control teams and 184 were admitted to the experimental teams (81 to the one-intern team and 103 to the two-intern team). Patients admitted to the experimental and control teams had similar age and disease severity. Residents and attending physicians consistently indicated that the quality of the educational experience, time spent teaching, time devoted to patient care, and quality of life were superior on the experimental teams. Objective healthcare outcomes did not differ between experimental and control teams.ConclusionsAltering internal medicine ward team structure to reduce the ratio of housestaff to attending physicians improved the perceived educational experience without altering objective healthcare outcomes

Comparison of Patients on Experimental vs. Standard Teams.

*<p>IQ = interquartile, CI = confidence interval.</p

Number of Admissions for Experimental and Standard Ward Teams.

<p>Number of Admissions for Experimental and Standard Ward Teams.</p

Resident Likert Satisfaction Survey^*.

*<p>1 = much worse or less than previous rotations; 2 = worse or less than previous rotations; 3 = same as previous rotations; 4 = improved or more than previous rotations; 5 = much improved or much more than previous rotations.</p

Attending Likert Satisfaction Survey^*.

*<p>1 = much worse or less than previous rotations; 2 = worse or less than previous rotations; 3 = same as previous rotations; 4 = improved or more than previous rotations; 5 = much improved or much more than previous rotations.</p