Carnegie Mellon University

icu

August 07, 2018

Studying ICU Teams Could Lead to Improved Patient Outcomes

Effective teamwork is a goal of any workplace. But few settings offer higher stakes than the fast-paced, life-or-death environment of a hospital’s intensive care unit.

Team collaboration in ICUs is an area ripe for exploration, according to a review co-authored by Carnegie Mellon University’s Taya Cohen, associate professor of organizational behavior and theory and the Carnegie Bosch Junior Faculty Chair, and Laurie Weingart, interim provost and the Richard M. and Margaret S. Cyert Professor of Organizational Behavior and Theory.

Part of what makes the ICU such a challenging setting to study is the unorthodox structure of its teams, Cohen said.

“Most research deals with clearly defined teams, but that’s not the case in the ICU,” she said. “It’s not completely clear which clinicians should be considered members of the team. Nurses, for example, may work with different sets of people than do the dietician or the respiratory therapist.”

Moreover, ICU teams don’t work together for long spells. A patient might spend two weeks in the unit but never see the same team together for a day, or a week, of that stay. And team members make life-and-death decisions quickly while collaborating with colleagues they may never have worked with before or again.

All these factors can contribute to breakdowns in communication, information sharing, and — ultimately — in outcomes, Cohen said.

“There are many different physical and emotional constraints,” she added.

“Effective teamwork is essential to the delivery of health care,” Weingart said. “As the work becomes more complex and, as a result, jobs become more specialized, more work is being done by teams who need to share information and coordinate their work.  Effective collaboration, communication, and coordination is even more necessary today than it was in the past.”

The paper, which was published in American Psychologist, suggests that more research is needed to develop interventions that will lead to better care for patients. In addition to Cohen and Weingart, contributors included Jeremy Kahn and Jennifer Ervin of the University of Pittsburgh.

“Over 4 million Americans are admitted to an ICU each year. Interprofessional collaboration is a cornerstone of modern critical care, yet we know shockingly little about how ICU teams function or how to make them function better,” Kahn said. “Through this work, we hope to leverage the power of the ICU team to improve the quality of critical care and save lives in the ICU.”

As a creator of many interdisciplinary programs and research efforts, the importance of collaboration was a crucial element for Weingart.

“Humans are the building blocks of all teams, and ICU teams are no different. Thus, we can take insights from one domain and transfer them to another,” she said.

“ICU teams require collaboration amongst specialists who have distinct knowledge bases, value systems, and beliefs,” Weingart said. “To capitalize on the diversity of perspective, team members must be willing and able to integrate alternative views.”

To approach this challenging team structure, the researchers identified communications processes within an ICU. For example, some teams use checklists, which can be time consuming and implemented imperfectly. In addition, some obstacles exist in an ICU environment that discourage open conversations.

Communication is most effective when people feel they can express themselves honestly, Cohen said. If team members think they will experience backlash within the ICU hierarchy for bringing up a tough issue, or if a patient’s family member is present during rounds and clinicians are reluctant to discuss sensitive information, patient care can be impacted.

“The leader of the ICU team can play an important role in creating a culture and atmosphere of psychological safety,” Cohen said.

Therefore, researchers need to determine ways to measure outcomes from ICU teams. However, within this environment, there is not always a clear right answer or a best solution to any given problem, the paper notes.

The researchers now are collecting survey data in ICUs across Pennsylvania. During their next phase, they’ll examine how teamwork processes and experiences affect performance.

“Because the stakes are so high, it makes the ICU an interesting context to look at,” Cohen said. “We can make a difference. In this setting, there’s the potential to save lives.”