Study protocol

Structuring communication relationships for interprofessional teamwork (SCRIPT): a cluster randomized controlled trial

Merrick Zwarenstein^1,2,3 , Scott Reeves^1,4,5 , Ann Russell¹ , Chris Kenaszchuk¹ , Lesley Gotlib Conn⁶ , Karen-Lee Miller¹ , Lorelei Lingard^5,7 and Kevin E Thorpe^1,8

¹Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Canada, M5B 1W8

²Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, 155 College Street, Suite 425, Toronto, Canada, M5T 3M6

³Sunnybrook Health Sciences Centre Research Institute, 2075 Bayview Avenue, Toronto, Canada, M4N 3M5

⁴Centre for Faculty Development, St. Michael's Hospital, 30 Bond Street, Toronto, Canada, M5B 1W8

⁵Wilson Centre for Research in Education, University of Toronto and University Health Network, 200 Elizabeth Street, 1ES-565, Toronto, Canada, M5G 2C4

⁶Office of Interprofessional Education, University of Toronto and University Health Network, 750 Dundas Street West, Suite 3-302, Toronto, Canada, M6J 3S3

⁷Department of Paediatrics, Faculty of Medicine, University of Toronto

⁸Department of Public Health Sciences, Faculty of Medicine, University of Toronto, 155 College Street, 6^th Floor, Toronto, Canada, M5T 3M7

author email corresponding author email

Trials 2007, 8:23doi:10.1186/1745-6215-8-23

Published:	18 September 2007

Abstract

Background

Despite a burgeoning interest in using interprofessional approaches to promote effective collaboration in health care, systematic reviews find scant evidence of benefit. This protocol describes the first cluster randomized controlled trial (RCT) to design and evaluate an intervention intended to improve interprofessional collaborative communication and patient-centred care.

Objectives

The objective is to evaluate the effects of a four-component, hospital-based staff communication protocol designed to promote collaborative communication between healthcare professionals and enhance patient-centred care.

Methods

The study is a multi-centre mixed-methods cluster randomized controlled trial involving twenty clinical teaching teams (CTTs) in general internal medicine (GIM) divisions of five Toronto tertiary-care hospitals. CTTs will be randomly assigned either to receive an intervention designed to improve interprofessional collaborative communication, or to continue usual communication practices.

Non-participant naturalistic observation, shadowing, and semi-structured, qualitative interviews were conducted to explore existing patterns of interprofessional collaboration in the CTTs, and to support intervention development. Interviews and shadowing will continue during intervention delivery in order to document interactions between the intervention settings and adopters, and changes in interprofessional communication.

The primary outcome is the rate of unplanned hospital readmission. Secondary outcomes are length of stay (LOS); adherence to evidence-based prescription drug therapy; patients' satisfaction with care; self-report surveys of CTT staff perceptions of interprofessional collaboration; and frequency of calls to paging devices. Outcomes will be compared on an intention-to-treat basis using adjustment methods appropriate for data from a cluster randomized design.

Discussion

Pre-intervention qualitative analysis revealed that a substantial amount of interprofessional interaction lacks key core elements of collaborative communication such as self-introduction, description of professional role, and solicitation of other professional perspectives. Incorporating these findings, a four-component intervention was designed with a goal of creating a culture of communication in which the fundamentals of collaboration become a routine part of interprofessional interactions during unstructured work periods on GIM wards.

Trial registration

Registered with National Institutes of Health as NCT00466297.