Interprofessional Team
Quality of interprofessional collaboration in the medical intensive care unit: perceptions by caregivers
A recent study examining caregivers’ perceptions of team interactions and interprofessional collaborative practice (IPCP) behaviors offers new, exciting insights on the importance of interprofessional team functioning in the medical intensive care unit (MICU) (Chen DW, et al. J Gen Intern Med. 2018;33[10]:1708).
Dr. Justin K. Lui
The Support Person Jefferson Teamwork Observation Guide (JTOG)TM survey was administered to 161 random caregivers of patients hospitalized in a single large urban academic medical center MICU between May 2016 and December 2016. The survey tool was designed to elicit the perceptions of caregivers regarding team functioning. Survey questions were directly mapped to the 2011 Interprofessional Education Collaborative (IPEC) Expert Panel core competencies for IPCP and divided into four domains (values/ethics; interprofessional communication; roles/responsibilities; teams/teamwork).
Dr. Mary Jo Farmer
Also appended to the surveys were additional follow-up questions that addressed the overall satisfaction with the team and general attitudes regarding the importance of interprofessional team-based care. Caregivers agreed on the importance of health-care professionals working together as a team to provide patient care (3.97/4.00 Likert scale 4 = extremely important). Caregivers expressed satisfaction with the MICU team (3.74/4.00). Furthermore, caregivers agreed that the MICU team demonstrated competencies in all four domains of IPCP: values/ethics (3.55/4.00), interprofessional communication (3.58/4.00), roles/responsibilities (3.61/4.00), and teams/teamwork (3.64/4.00). Caregivers felt the MICU team provided patient/family-centered care (sub-competency 3.58/4.00). Notably, the overall caregiver survey scores detailing how well each MICU team functioned were positively correlated to overall satisfaction with the MICU team (r = 0.596 P < .01).
Dr. Kristina E. Ramirez
Limitations of the study included:
1. The sample is from a single institution, and perceptions of caregivers cannot be applied to all populations.
2. No information regarding patient, such as diagnosis, was obtained.
3. Caregivers satisfied with care might be more likely to participate.
4. No distinction was made between data collected from caregivers surveyed in the resident-fellow staffed MICU vs NP-staffed MICU.
It has been described that ineffective teamwork and team communication in health care settings are associated with increased patient harm and sentinel events (Kohn LT et al. Washington (DC): National Academies Press(US); 2000); (Page A, Washington (DC): National Academies Press (US); (The Joint Commission. Sentinel Event Alert 2008, 40); (Brennan TA, et al. N Engl J Med. 1991;324:370). Cultural differences between members of the health-care team and established hierarchies of control have been identified as barriers to communication and teamwork in ICUs (Alexanian JA, et al. J Crit Care Med. 2015;43[9]:1880); (Manias E, Street A. Int J Nurs Stud. 2001;38[2]:129).
Overall, the findings from this study emphasize the importance of interprofessional communication and teamwork in the MICU and delivery of patient/family-centered care from the caregivers’ perspective. The unique insight into caregivers’ perspectives on specific team behaviors may be the basis for future quality improvement initiatives.
Justin K. Lui, MD,
Mary Jo Farmer, MD, PhD, FCCP
Kristina E. Ramirez, RRT, MPH, FCCP