Exploring the process of information sharing in an adult intensive care unit: an ethnographic study

Boltey, Emily M; Wright, Nathan; Mosley, Elizabeth A.; White, Matthew R; Iwashyna, Theodore J.; Manojlovich, Milisa; Costa, Deena Kelly

doi:10.1080/13561820.2021.1899147

Cited by 4 publications

(3 citation statements)

References 24 publications

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“…Our findings also have important implications for those who design and implement interventions to improve goal-aligned care in the ICU. Prior interventions in this area have primarily focused on individual-level communication between team members and surrogates ( 32 – 34 , 36 – 40 ). Our findings suggest that intrateam interactions can be an important mechanism in aligning ICU care with patient goals and, thus, are a promising target for new interventions.…”

Section: Discussionmentioning

confidence: 99%

Impact of Interprofessional Teamwork on Aligning Intensive Care Unit Care with Patient Goals: A Qualitative Study of Transactive Memory Systems

et al. 2023

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Rationale Although aligning care with patient goals is fundamental to critical care, this process is often delayed and leads to conflict among patients, families, and intensive care unit (ICU) teams. Interprofessional collaboration within ICU teams is an opportunity to improve goal-aligned care, yet this collaboration is poorly understood. A better understanding of how ICU team members work together to provide goal-aligned care may identify new strategies for improvement. Objectives Transactive memory systems is a theory of group mind that explains how high-performing teams use a shared memory and collective cognition. We applied this theory to characterize the process of interprofessional collaboration within ICU teams and its relationship with goal-aligned care. Methods We conducted a secondary analysis of focus group ( n = 10) and semistructured interview ( n = 8) transcripts, gathered during a parent study at two academic medical centers on the process of ICU care delivery in acute respiratory failure. Participants ( N = 70) included interprofessional ICU and palliative care team members, surrogates, and patient survivors. We used directed content analysis, applying transactive memory systems theory and its major components (specialization, coordination, credibility) to examine ICU team collaboration. Results Participants described each ICU profession as having a specialized role in aligning care with patient goals. Different professions have different opportunities to gather knowledge about patient goals and priorities, which results in dispersion of this knowledge among different team members. To share and use this dispersed knowledge, ICU teams rely on an informal coordination process and “side conversations.” This process is a workaround for formal channels (e.g., health records, interprofessional rounds) that do not adequately convey knowledge about patient goals. This informal process does not occur if team members are discouraged from asserting their knowledge because of hierarchy or lack of psychological safety. Conversely, coordination succeeds when team members recognize each other as credible sources of valued knowledge. Conclusions We found that ICU team members work together to align care with patient goals and priorities, using transactive memory systems. The successful function of these systems can be disrupted or promoted by ICU organizational and cultural factors, which are potential targets for efforts to increase goal-aligned care.

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Section: Discussionmentioning

confidence: 99%

Impact of Interprofessional Teamwork on Aligning Intensive Care Unit Care with Patient Goals: A Qualitative Study of Transactive Memory Systems

et al. 2023

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“…Furthermore, participants endorsed the need for P/CCI patients and families to be consulted when goals and care planning. In an ethnographic study of information sharing in an adult ICU, Boltey et al (2022) explain that supporting patient and family engagement can allow for trust building. These authors suggest care process strategies such as including patients and families in rounds and assessing information needs of family members (Boltey et al, 2022).…”

Section: Institutional Levelmentioning

confidence: 99%

“…In an ethnographic study of information sharing in an adult ICU, Boltey et al (2022) explain that supporting patient and family engagement can allow for trust building. These authors suggest care process strategies such as including patients and families in rounds and assessing information needs of family members (Boltey et al, 2022). Given their prolonged ICU admission and slower trajectory of recovery, P/CCI patients would benefit from a "team" approach where team composition is reviewed and goals are set mutually (Costa, 2019).…”

Section: Institutional Levelmentioning

confidence: 99%

Clinician‐perceived barriers and facilitators for the provision of actionable processes of care important for persistent or chronic critical illness

Istanboulian,

Dale,

Terblanche

et al. 2023

Journal of Advanced Nursing

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AimTo explore clinician‐perceived barriers to and facilitators for the provision of actionable processes of care important for patients with persistent or chronic critical illness.DesignQualitative descriptive interview study.MethodsSecondary analysis of semi‐structured telephone interviews (December 2018 – February 2019) with professionally diverse clinicians working with adults experiencing persistent or chronic critical illness in Canadian intensive care units. We used deductive content analysis informed by the Social‐Ecological Model.ResultsWe recruited 31 participants from intensive care units across nine Canadian provinces. Reported intrapersonal level barriers to the provision of actionable processes of care included lack of training, negative emotions and challenges prioritizing these patients. Facilitators included establishment of positive relations and trust with patients and family. Interpersonal barriers included communication difficulties, limited access to physicians and conflict. Facilitators included communication support, time spent with the patient/family and conflict management. Institutional barriers comprised inappropriate care processes, inadequate resources and disruptive environmental conditions. Facilitators were regular team rounds, appropriate staffing and employment of a primary care (nurse and/or physician) model. Community‐level barriers included inappropriate care location and insufficient transition support. Facilitators were accessed to alternate care sites/teams and to formalized transition support. Public policy‐level barriers included inadequacy of formal education programs for the care of these patients; knowledge implementation for patient management was identified as a facilitator.ConclusionOur results highlighted multilevel barriers and facilitators to the delivery of actionable processes important for quality care for patient/family experiencing persistent or chronic critical illness.ImpactUsing the Social‐Ecological Model, the results of this study provide intra and interpersonal, institutional, community and policy‐level barriers to address and facilitators to harness to improve the care of patients/family experiencing persistent or chronic critical illness.Reporting MethodConsolidated criteria for reporting qualitative studies.Patient or Public ContributionNo patient or public contribution.

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A qualitative study of how team characteristics and leadership are associated with information sharing in multidisciplinary intensive care units

Abahuje

Díaz

Lin

et al. 2023

Surgery

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Exploring the process of information sharing in an adult intensive care unit: an ethnographic study

Cited by 4 publications

References 24 publications

Impact of Interprofessional Teamwork on Aligning Intensive Care Unit Care with Patient Goals: A Qualitative Study of Transactive Memory Systems

Impact of Interprofessional Teamwork on Aligning Intensive Care Unit Care with Patient Goals: A Qualitative Study of Transactive Memory Systems

Clinician‐perceived barriers and facilitators for the provision of actionable processes of care important for persistent or chronic critical illness

A qualitative study of how team characteristics and leadership are associated with information sharing in multidisciplinary intensive care units

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