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  1. Article ; Online: A mixed methods case study investigating how randomised controlled trials (RCTs) are reported, understood and interpreted in practice.

    Byrne, Ben E / Rooshenas, Leila / Lambert, Helen S / Blazeby, Jane M

    BMC medical research methodology

    2020  Volume 20, Issue 1, Page(s) 112

    Abstract: Background: While randomised controlled trials (RCTs) provide high-quality evidence to guide practice, much routine care is not based upon available RCTs. This disconnect between evidence and practice is not sufficiently well understood. This case study ...

    Abstract Background: While randomised controlled trials (RCTs) provide high-quality evidence to guide practice, much routine care is not based upon available RCTs. This disconnect between evidence and practice is not sufficiently well understood. This case study explores this relationship using a novel approach. Better understanding may improve trial design, conduct, reporting and implementation, helping patients benefit from the best available evidence.
    Methods: We employed a case-study approach, comprising mixed methods to examine the case of interest: the primary outcome paper of a surgical RCT (the TIME trial). Letters and editorials citing the TIME trial's primary report underwent qualitative thematic analysis, and the RCT was critically appraised using validated tools. These analyses were compared to provide insight into how the TIME trial findings were interpreted and appraised by the clinical community.
    Results: 23 letters and editorials were studied. Most authorship included at least one academic (20/23) and one surgeon (21/23). Authors identified wide-ranging issues including confounding variables or outcome selection. Clear descriptions of bias or generalisability were lacking. Structured appraisal identified risks of bias. Non-RCT evidence was less critically appraised. Authors reached varying conclusions about the trial without consistent justification. Authors discussed aspects of internal and external validity covered by appraisal tools but did not use these methodological terms in their articles.
    Conclusions: This novel method for examining interpretation of an RCT in the clinical community showed that published responses identified limited issues with trial design. Responses did not provide coherent rationales for accepting (or not) trial results. Findings may suggest that authors lacked skills in appraisal of RCT design and conduct. Multiple case studies with cross-case analysis of other trials are needed.
    Language English
    Publishing date 2020-05-12
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2041362-2
    ISSN 1471-2288 ; 1471-2288
    ISSN (online) 1471-2288
    ISSN 1471-2288
    DOI 10.1186/s12874-020-01009-8
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  2. Article ; Online: The end of bursectomy for gastric cancer?

    Byrne, Ben E / Rogers, Chris A / Blazeby, Jane M

    The lancet. Gastroenterology & hepatology

    2018  Volume 3, Issue 7, Page(s) 446–447

    MeSH term(s) Biopsy ; Humans ; Neoplasm Recurrence, Local ; Stomach Neoplasms
    Language English
    Publishing date 2018-04-28
    Publishing country Netherlands
    Document type Journal Article ; Comment
    ISSN 2468-1253
    ISSN (online) 2468-1253
    DOI 10.1016/S2468-1253(18)30135-3
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  3. Article ; Online: A Protocol is not Enough: Enhanced Recovery Program-Based Care and Clinician Adherence Associated with Shorter Stay After Colorectal Surgery.

    Byrne, Ben E / Faiz, Omar D / Bottle, Alex / Aylin, Paul / Vincent, Charles A

    World journal of surgery

    2020  Volume 45, Issue 2, Page(s) 347–355

    Abstract: Background: Randomised trials have shown an Enhanced Recovery Program (ERP) can shorten stay after colorectal surgery. Previous research has focused on patient compliance neglecting the role of care providers. National data on implementation and ... ...

    Abstract Background: Randomised trials have shown an Enhanced Recovery Program (ERP) can shorten stay after colorectal surgery. Previous research has focused on patient compliance neglecting the role of care providers. National data on implementation and adherence to standardised care are lacking. We examined care organisation and delivery including the ERP, and correlated this with clinical outcomes.
    Methods: A cross-sectional questionnaire was administered to surgeons and nurses in August-October 2015. All English National Health Service Trusts providing elective colorectal surgery were invited. Responses frequencies and variation were examined. Exploratory factor analysis was performed to identify underlying features of care. Standardised factor scores were correlated with elective clinical outcomes of length of stay, mortality and readmission rates from 2013-15.
    Results: 218/600 (36.3%) postal responses were received from 84/90 (93.3%) Trusts that agreed to participate. Combined with email responses, 301 surveys were analysed. 281/301 (93.4%) agreed or strongly agreed that they had a standardised, ERP-based care protocol. However, 182/301 (60.5%) indicated all consultants managed post-operative oral intake similarly. After factor analysis, higher hospital average ERP-based care standardisation and clinician adherence score were significantly correlated with reduced length of stay, as well as higher ratings of teamwork and support for complication management.
    Conclusions: Standardised, ERP-based care was near universal, but clinician adherence varied markedly. Units reporting higher levels of clinician adherence achieved the lowest length of stay. Having a protocol is not enough. Careful implementation and adherence by all of the team is vital to achieve the best results.
    MeSH term(s) Colectomy/standards ; Colectomy/statistics & numerical data ; Cross-Sectional Studies ; Digestive System Surgical Procedures/standards ; Digestive System Surgical Procedures/statistics & numerical data ; Elective Surgical Procedures/standards ; Enhanced Recovery After Surgery ; Guideline Adherence/statistics & numerical data ; Health Care Surveys/statistics & numerical data ; Hospital Mortality ; Humans ; Length of Stay/statistics & numerical data ; Patient Readmission/statistics & numerical data ; Perioperative Care/standards ; Proctectomy/standards ; Proctectomy/statistics & numerical data ; United Kingdom/epidemiology
    Language English
    Publishing date 2020-10-20
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-020-05810-w
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    Zs.A 1336: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (1.OG)
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  4. Article ; Online: Do patients with gastrointestinal cancer want to decide where they have tests and surgery? A questionnaire study of provider choice.

    Byrne, Ben E / Faiz, Omar D / Vincent, Charles

    BMJ quality & safety

    2016  Volume 25, Issue 9, Page(s) 696–703

    Abstract: Backgrounds: Choice of provider has been an important strategy among policy makers, intended, in part, to drive improvements in quality and efficiency of healthcare. This study examined the information requirements, and decision-making experiences and ... ...

    Abstract Backgrounds: Choice of provider has been an important strategy among policy makers, intended, in part, to drive improvements in quality and efficiency of healthcare. This study examined the information requirements, and decision-making experiences and preferences of patients who have had surgery for gastrointestinal cancer, to assess the status of provider choice in current practice.
    Methods: The single-item Control Preferences Scale was used to determine patients' experiences and preferences when being referred for tests, and choosing where to have surgery. Participants used a Likert scale to rate the importance of 23 information items covering a variety of structures, processes and outcomes at the hospital level and the department level. Participants were recruited by post and online.
    Results: 463 responses were analysed. Patients reported very low levels of involvement in provider choice, with their doctor deciding where they underwent tests or surgery in 77.0% and 81.8% of cases, respectively. Over two-thirds of participants would have preferred greater involvement in provider choice than they experienced. Of note, patient age and education were not associated with reported preferences. Information on how long patients with cancer wait for treatment, annual operative volume and postoperative mortality rate, as well as retained foreign bodies and infection rates were considered very important.
    Conclusions: There was a substantial unmet desire for greater involvement in provider choice among study participants. Respondents attached particular importance to surgery-specific information. Efforts should be made to increase involvement of patients with gastrointestinal cancer in provider decisions, across primary and secondary care, to deliver more patient-centred care. The reported lack of patient involvement in provider choice suggests it is unlikely to be working as an effective lever to drive quality improvement at present.
    Language English
    Publishing date 2016-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 2592912-4
    ISSN 2044-5423 ; 2044-5415
    ISSN (online) 2044-5423
    ISSN 2044-5415
    DOI 10.1136/bmjqs-2015-004194
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  5. Article ; Online: Endoscopic tumour morphology impacts survival in adenocarcinoma of the oesophagus.

    Knight, William R C / McEwen, Ricardo / Byrne, Ben E / Habib, Wais / Bott, Rebecca / Zylstra, Janine / Mahadeva, Ula / Gossage, James A

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2020  Volume 46, Issue 12, Page(s) 2257–2261

    Abstract: Background: Prognostication in oesophageal cancer on the basis of preoperative variables is challenging. Many of the accepted predictors of survival are only derived after surgical treatment and may be influenced by neoadjuvant therapy. This study aims ... ...

    Abstract Background: Prognostication in oesophageal cancer on the basis of preoperative variables is challenging. Many of the accepted predictors of survival are only derived after surgical treatment and may be influenced by neoadjuvant therapy. This study aims to explore the relationship between pre-treatment endoscopic tumour morphology and postoperative survival.
    Methods: Patients with endoscopic descriptions of tumours were identified from the prospectively managed databases including the OCCAMS database. Tumours were classified as exophytic, ulcerating or stenosing. Kaplan Meier survival analysis and multivariable Cox regression analyses were performed to determine hazard ratios (HR) with 95% confidence intervals.
    Results: 262 patients with oesophageal adenocarcinoma undergoing potentially curative resection were pooled from St Thomas' Hospital (161) and the OCCAMS database (101). There were 70 ulcerating, 114 exophytic and 78 stenosing oesophageal adenocarcinomas. Initial tumour staging was similar across all groups (T3/4 tumours 71.4%, 70.2%, 74.4%). Median survival was 55 months, 51 months and 36 months respectively (p < 0.001). Rates of lymphovascular invasion (P = 0.0176), pathological nodal status (P = 0.0195) and pathological T stage (P = 0.0007) increased from ulcerating to exophytic to stenosing lesions. Resection margin positivity was 21.4% in ulcerating tumours compared to 54% in stenosing tumours (p < 0.001). When compared to stenosing lesions, exophytic and ulcerating lesions demonstrated a significant survival advantage on multivariable analysis (HR 0.56 95% CI 0.31-0.93, HR 0.42 95% CI 0.21-0.82).
    Conclusion: This study demonstrates that endoscopic morphology may be an important pre-treatment prognostic factor in oesophageal cancer. Ulcerating, exophytic and stenosing tumours may represent different pathological processes and tumour biology.
    MeSH term(s) Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Constriction, Pathologic/pathology ; Endoscopy, Digestive System ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/surgery ; Esophagectomy ; Esophagogastric Junction/pathology ; Humans ; Kaplan-Meier Estimate ; Lymph Nodes/pathology ; Margins of Excision ; Multivariate Analysis ; Neoadjuvant Therapy ; Neoplasm Grading ; Neoplasm Invasiveness ; Neoplasm Staging ; Polyps/pathology ; Prognosis ; Proportional Hazards Models ; Survival Rate ; Tumor Burden ; Ulcer/pathology
    Language English
    Publishing date 2020-07-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2020.07.003
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1149: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)
    Zs.MO 549: Show issues

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  6. Article ; Online: Patient perspectives on key symptoms and preferences for follow-up after upper gastro-intestinal cancer surgery.

    Pucher, Philip H / Coombes, Annie / Evans, Orla / Taylor, Joanna / Moore, Jonathan L / White, Annabelle / Lagergren, Jesper / Baker, Cara / Kelly, Mark / Gossage, James A / Dunn, Jason / Zeki, Sebastian / Byrne, Ben E / Andreyev, Jervoise / Davies, Andrew R

    Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

    2022  Volume 30, Issue 6, Page(s) 5269–5275

    Abstract: Purpose: Long-lasting symptoms and reductions in quality of life are common after oesophago-gastric surgery. Post-operative follow-up has traditionally focussed on tumour recurrence and survival, but there is a growing need to also identify and treat ... ...

    Abstract Purpose: Long-lasting symptoms and reductions in quality of life are common after oesophago-gastric surgery. Post-operative follow-up has traditionally focussed on tumour recurrence and survival, but there is a growing need to also identify and treat functional sequelae to improve patients' recovery.
    Methods: An electronic survey was circulated via a British national charity for patients undergoing oesophago-gastric surgery and their families. Patients were asked about post-operative symptoms they deemed important to their quality of life, as well as satisfaction and preferences for post-operative follow-up. Differences between satisfied and dissatisfied patients with reference to follow-up were assessed.
    Results: Among 362 respondents with a median follow-up of 58 months since surgery (range 3-412), 36 different symptoms were reported as being important to recovery and quality of life after surgery, with a median of 13 symptoms per patient. Most (84%) respondents indicated satisfaction with follow-up. Satisfied patients were more likely to have received longer follow-up (5-year or longer follow-up 60% among satisfied patients vs 27% among unsatisfied, p < 0.001). These were also less likely to have seen a dietitian as part of routine follow-up (37% vs 58%, p = 0.005).
    Conclusion: This patient survey highlights preferences regarding follow-up after oesophago-gastrectomy. Longer follow-up and dietician involvement improved patient satisfaction. Patients reported being concerned by a large number of gastrointestinal and non-gastrointestinal symptoms, highlighting the need for multidisciplinary input and a consensus on how to manage the poly-symptomatic patient.
    MeSH term(s) Esophageal Neoplasms/surgery ; Follow-Up Studies ; Gastrectomy ; Humans ; Intestinal Neoplasms ; Neoplasm Recurrence, Local ; Quality of Life ; Stomach Neoplasms/surgery
    Language English
    Publishing date 2022-03-11
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1134446-5
    ISSN 1433-7339 ; 0941-4355
    ISSN (online) 1433-7339
    ISSN 0941-4355
    DOI 10.1007/s00520-022-06922-w
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    Zs.A 3697: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  7. Article ; Online: Outlier identification in colorectal surgery should separate elective and nonelective service components.

    Byrne, Ben E / Mamidanna, Ravikrishna / Vincent, Charles A / Faiz, Omar D

    Diseases of the colon and rectum

    2014  Volume 57, Issue 9, Page(s) 1098–1104

    Abstract: Background: The identification of health care institutions with outlying outcomes is of great importance for reporting health care results and for quality improvement. Historically, elective surgical outcomes have received greater attention than ... ...

    Abstract Background: The identification of health care institutions with outlying outcomes is of great importance for reporting health care results and for quality improvement. Historically, elective surgical outcomes have received greater attention than nonelective results, although some studies have examined both. Differences in outlier identification between these patient groups have not been adequately explored.
    Objective: The aim of this study was to compare the identification of institutional outliers for mortality after elective and nonelective colorectal resection in England.
    Design: This was a cohort study using routine administrative data. Ninety-day mortality was determined by using statutory records of death. Adjusted Trust-level mortality rates were calculated by using multiple logistic regression. High and low mortality outliers were identified and compared across funnel plots for elective and nonelective surgery.
    Settings: All English National Health Service Trusts providing colorectal surgery to an unrestricted patient population were studied.
    Patients: Adults admitted for colorectal surgery between April 2006 and March 2012 were included.
    Intervention(s): Segmental colonic or rectal resection was performed.
    Main outcome measures: The primary outcome measured was 90-day mortality.
    Results: Included were 195,118 patients, treated at 147 Trusts. Ninety-day mortality rates after elective and nonelective surgery were 4% and 18%. No unit with high outlying mortality for elective surgery was a high outlier for nonelective mortality and vice versa. Trust level, observed-to-expected mortality for elective and nonelective surgery, was moderately correlated (Spearman ρ = 0.50, p< 0.001).
    Limitations: This study relied on administrative data and may be limited by potential flaws in the quality of coding of clinical information.
    Conclusions: Status as an institutional mortality outlier after elective and nonelective colorectal surgery was not closely related. Therefore, mortality rates should be reported for both patient cohorts separately. This would provide a broad picture of the state of colorectal services and help direct research and quality improvement activities.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Colonic Diseases/surgery ; Colorectal Surgery/mortality ; Elective Surgical Procedures/mortality ; England/epidemiology ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Rectal Diseases/surgery ; Risk Factors
    Language English
    Publishing date 2014-09
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 212581-x
    ISSN 1530-0358 ; 0012-3706
    ISSN (online) 1530-0358
    ISSN 0012-3706
    DOI 10.1097/DCR.0000000000000192
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    Uk I Zs.237: Show issues Location:
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    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

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  8. Article: Understanding how colorectal units achieve short length of stay: an interview survey among representative hospitals in England.

    Byrne, Ben E / Pinto, Anna / Aylin, Paul / Bottle, Alex / Faiz, Omar D / Vincent, Charles A

    Patient safety in surgery

    2015  Volume 9, Issue 1, Page(s) 2

    Abstract: Background: Wide variation in the outcomes of colorectal surgery persists, despite a well-established evidence-base to inform clinical practice. This variation may be attributed to differences in quality of care, but we do not know what this means in ... ...

    Abstract Background: Wide variation in the outcomes of colorectal surgery persists, despite a well-established evidence-base to inform clinical practice. This variation may be attributed to differences in quality of care, but we do not know what this means in practical terms of care delivery. This telephone interview study aimed to identify distinguishing characteristics in the organisation of care among colorectal units with the best length of stay results in England.
    Methods: Ten English National Health Service hospitals were identified with the shortest length of stay after elective colonic surgery between January 2011 and December 2012. Semi-structured telephone interviews were conducted with a senior colorectal surgeon and ward nurse, who were not informed of their performance, at each site. Audio recordings were professionally transcribed and thematically analysed for similarities and differences in practice between units.
    Results: All ten short length of stay units approached agreed to participate, and 19 of 20 interviews were recorded. These units standardised clinical care based upon an Enhanced Recovery Program. Beyond this, they organised the clinical team to efficiently and reliably deliver this package of care, with the majority of day-to-day care delivered by consultants and nurses. Patients were closely monitored for postoperative deterioration, using a combination of early warning scores, nurses' clinical judgement and regular senior medical review. Of note, operative volume and laparoscopy rates in these units were not statistically significantly different from the national average (p = 0.509 and p = 0.131, respectively). The postoperative analgesic strategy varied widely between units, from routine epidural use to local anaesthetic infiltration or patient-controlled analgesia.
    Conclusions: The Enhanced Recovery Program may be seen as necessary but not sufficient to achieve the best length of stay results. In the study units, consultants and nurses led and delivered the majority of patient care on the ward. High quality teamwork helped detect and resolve clinical issues promptly, with nurses empowered to contact consultants directly if needed. Other units may learn from these teams by adopting protocol-based, consultant- or nurse-delivered care, and by improving coordination and communication between consultants and ward nurses.
    Language English
    Publishing date 2015-01-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 2409244-7
    ISSN 1754-9493
    ISSN 1754-9493
    DOI 10.1186/s13037-014-0050-5
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  9. Article ; Online: Surgery, Complications, and Quality of Life: A Longitudinal Cohort Study Exploring the Role of Psychosocial Factors.

    Archer, Stephanie / Pinto, Anna / Vuik, Sabine / Bicknell, Colin / Faiz, Omar / Byrne, Ben / Johnston, Maximilian / Skapinakis, Petros / Athanasiou, Thanos / Vincent, Charles / Darzi, Ara

    Annals of surgery

    2018  Volume 270, Issue 1, Page(s) 95–101

    Abstract: Objective: To determine whether psychosocial factors moderate the relationship between surgical complications and quality of life (QoL).: Background: Patients who experience surgical complications have significantly worse postoperative QoL than ... ...

    Abstract Objective: To determine whether psychosocial factors moderate the relationship between surgical complications and quality of life (QoL).
    Background: Patients who experience surgical complications have significantly worse postoperative QoL than patients with an uncomplicated recovery. Psychosocial factors, such as coping style and level of social support influence how people deal with stressful events, but it is unclear whether they affect QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients postoperatively.
    Methods: This is a longitudinal cohort study; data were collected pre-op, 1 month post-op, 4 months post-op, and 12 months post-op. A total of 785 patients undergoing major elective gastrointestinal, vascular, or cardiothoracic surgery who were recruited from 28 National Health Service sites in England and Scotland took part in the study.
    Results: Patients who experience major surgical complications report significantly reduced levels of physical and mental QoL (P < 0.05) but they make a full recovery over time. Findings indicate that a range of psychosocial factors such as the use of humor as a coping style and the level of health care professional support may moderate the impact of surgical complications on QoL.
    Conclusions: Surgical complications alongside other sociodemographic and psychosocial factors contribute to changes in QoL; the results from this exploratory study suggest that interventions that increase the availability of healthcare professional support and promote more effective coping strategies before surgery may be useful, particularly in the earlier stages of recovery where QoL is most severely compromised. However, these relationships should be further explored in longitudinal studies that include other types of surgery and employ rigorous recruitment and follow-up procedures.
    MeSH term(s) Adaptation, Psychological ; Adult ; Aged ; Aged, 80 and over ; Female ; Health Status Indicators ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Postoperative Complications/physiopathology ; Postoperative Complications/psychology ; Quality of Life/psychology ; Social Determinants of Health ; Social Support
    Language English
    Publishing date 2018-03-19
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000002745
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    Uk I Zs.35/1: Show issues Location:
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  10. Article ; Online: Effects of Interdisciplinary Team Care Interventions on General Medical Wards: A Systematic Review.

    Pannick, Samuel / Davis, Rachel / Ashrafian, Hutan / Byrne, Ben E / Beveridge, Iain / Athanasiou, Thanos / Wachter, Robert M / Sevdalis, Nick

    JAMA internal medicine

    2015  Volume 175, Issue 8, Page(s) 1288–1298

    Abstract: Importance: Improving the quality of health care for general medical patients is a priority, but the organization of general medical ward care receives less scrutiny than the management of specific diseases. Optimizing teams' performance improves ... ...

    Abstract Importance: Improving the quality of health care for general medical patients is a priority, but the organization of general medical ward care receives less scrutiny than the management of specific diseases. Optimizing teams' performance improves patient outcomes in other settings, and interdisciplinary practice is a major target for improvement efforts. However, the effect of interdisciplinary team interventions on general medical ward care has not been systematically reviewed.
    Objectives: To describe the range of objective patient outcomes used in studies of general medical ward interdisciplinary team care, and to evaluate the performance of interdisciplinary interventions against them.
    Evidence review: We searched EMBASE, MEDLINE, and PsycINFO from January 1, 1998, through December 31, 2013, for interdisciplinary team care interventions in adult general medical wards using an objective patient outcome measure. Reference lists of included articles were also searched. The last search was conducted on January 29, 2014, and the narrative and statistical analysis was conducted through December 1, 2014. Study quality was assessed using the Cochrane Effective Practice and Organization of Care group's tool.
    Findings: Thirty of 6934 articles met the selection criteria. The studies included 66,548 patients, with a mean age of 63 years. Nineteen of 30 (63%) studies reported length of stay, readmission, or mortality rate as their primary outcome, or did not specify the primacy of their outcomes. The most commonly reported objective patient outcomes were length of stay (23 of 30 [77%]), complications of care (10 of 30 [33%]), in-hospital mortality rate (8 of 30 [27%]), and 30-day readmission rate (8 of 30 [27%]). Of 23 interventions, 16 (70%) had no effect on length of stay, 12 of 15 (80%) did not reduce readmissions, and 14 of 15 (93%) did not affect mortality. Five of 10 (50%) interventions reduced complications of care. In an exploratory quantitative analysis, the interventions did not consistently reduce the relative risk of early readmission or early mortality, or the weighted mean difference in length of stay. All studies had a medium or high risk of bias.
    Conclusions and relevance: Current evidence suggests that interdisciplinary team care interventions on general medical wards have little effect on traditional measures of health care quality. Complications of care or preventable adverse events may merit inclusion as quality indicators for general medical wards. Future study should clarify how best to implement interdisciplinary team care interventions and establish quality metrics that are credible to both health care professionals and patients in this setting.
    MeSH term(s) Hospital Mortality ; Hospital Units ; Hospitalization ; Humans ; Length of Stay ; Patient Care Team ; Patient Readmission ; Quality Improvement ; Quality of Health Care
    Language English
    Publishing date 2015-08
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 2699338-7
    ISSN 2168-6114 ; 2168-6106
    ISSN (online) 2168-6114
    ISSN 2168-6106
    DOI 10.1001/jamainternmed.2015.2421
    Database MEDical Literature Analysis and Retrieval System OnLINE

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