Collaboration and communication among all the team members of the Intensive Care Unit (ICU), where patient activity is high, goes a long way in promoting effective care of critically ill patients.
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.
1 Baggs JG, Schmitt MH, Mushlin AI, et al. Association between nurse-physician collaboration and patient outcomes in three intensive care units. Crit Car Med 1999;27:1991-1998.
2 National Institutes of Health. Consensus conference critical care medicine. JAMA 1983;250:789-804.
3 Joint Commission on Accreditation of Hospitals. Accreditation Manual for Hospitals. 2007; JCAHO Chicago IL.
4 American Association of Critical Care Nurses. Collaborative Practice Model: The Organization of Human Resources in Critical Care Units. AACN: Newport Beach CA
5 McCauley K, Irwin RS. Changing the work environment in intensive care units to achieve patient-focused care: the time has come. Am J Crit Care 2006;15:541-548.
6 Davidson JE, Powers K, Hedayat KM, et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Car Medicine Taskforce 2004-2005. Crit Care Med 2007;35:605-622.
7 Barnato AE, Kahn JM, Rubenfeld G. et al. Prioritizing the organization and management of intensive care services in the United States: The PrOMIS Conference. Crit Care Med 2007;35-1003-1011.
8 Baggs JG, Ryan SA, :Phelps CE, Richeson JF, Johnson JE. The association between interdisciplinary collaboration and patient outcomes in a medical intensive care unit. Heart & Lung 1993;21:18-24.
9 Baggs JC, Ryan SA, Phelps CE, et al. The association between interdisciplinary collaboration and patient outcomes in a medical intensive care unit. Heart Lung 1993;21:18-24.
10 Shortell SM et al. The performance of intensive care units: does good management make a difference? Medical Care 1994;32:508-525.
11 Knaus WA, Draper EA, Wagner DP, Zimmerman JE. An evaluation of outcomes from intensive care in major medical centers. Ann Intern Med 1986;10:410-418.
12 Zimmerman JE et al. Improving intensive care: a prospective, multicenter study. Crit Care Med 1993:21:1443-51.
13 Vazirani S, Hyas RD, Shaprios MF. Cowan M. Effect of a multidisciplinary intervention on communcation and collaboration among physicians and nurses. Am J Crit Care 2005;14:71-77.