Professor Rush University College of Nursing, USA.
Collaboration between physicians and nurses is an important component of effective care in the hospital setting. When working together toward common goals, collaboration has been identified as a way of improving care for the critically ill patients as it enables input from the multidisciplinary team members in promoting decision-making based on more useful information1 . Patient care depends on the interactions of various providers, especially in the Intensive Care Unit (ICU), where patient acuity levels are high and critical illness states often result in sudden changes, some of which are life-threatening. As a result, collaboration is vital in ensuring appropriate care and treatment of the critically ill patient.
The importance of collaboration and communication and its impact on patient outcomes in the ICU is well recognised by many national and international organisations. The Joint Commission, the American Association of Critical Care Nurses, the Society for Critical Care Medicine and the National Institutes of Health have previously advocated for interdisciplinary communication and collaboration for patient care in the ICU2,3,4 . Recent recommendations from the American College of Chest Physicians and the American Association of Critical Care Nurses also focus on the importance of skilled communication and true collaboration as essential elements for transforming work environments5 . The Society of Critical Care Medicine's clinical practice guidelines for patient-centered care in the ICU advocate for communication and shared decision-making to enhance care for the critically ill patient6 . Most recently, the results of a critical care consensus initiative identified that improving communication among providers and formal training on the interdisciplinary team model are advocated to improve the management of ICU services7 . As communication and collaboration are essential to patient-focussed care, open communication and interdisciplinary collaboration are key components in achieving patient-centred care and meeting patient care goals5.
A number of opportunities have been identified for improving collaboration in the ICU including participation of the multidisciplinary team in grand rounds, research and quality improvement initiatives (Table 2). Rapid response teams are one specific example of an institution-wide initiative that promotes collaboration among the ICU team members who serve as responders. Forming multidisciplinary teams to address clinical issues, formulating new protocols, or implementing best practices help to promote collaboration among the ICU team members. Specific examples of initiatives include forming a committee or task force to focus on sepsis identification, management, and implementation of the Surving Sepsis Campaign Guidelines, targeting hypoglycemia prevention for patients on intravenous insulin protocols, or promoting palliative care consultations in the ICU. Conducting research in the ICU offers additional experiences to promote collaboration among the ICU team. Other opportunities including publications and presentations of ICU team initiatives at local, regional and national forums, also promote collaboration among the ICU team members.
Multidisciplinary collaboration in the ICU is vital in ensuring appropriate care and treatment of the critically ill patients as well as an important component of establishing and meeting patient care goals. Collaboration should be encouraged and promotedon the ICU team as it is an essential component of high performance and helps to promote best patient outcomes.
Ruth M Kleinpell is currently the Director for Clinical Research and Scholarship at Rush University Medical Center and a Professor at Rush University College of Nursing. She maintains active practice as a Nurse Practitioner at Our Lady of the Resurrection Medical Center in Chicago, Illinois. She is an experienced researcher and clinician, an active member of several critical care organisations, and a member of the editorial boards of several journals. She is also a fellow of the American Academy of Nursing, the American Academy of Nurse Practitioners, the Institute of Medicine of Chicago and the American College of Critical Care Medicine.
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