ICU team composition and its association with ABCDE implementation in a quality collaborative

Costa, Deena Kelly; Valley, Thomas S.; Miller, Melissa A.; Manojlovich, Milisa; Watson, Sam R.; McLellan, Phyllis; Pope, Corine; Hyzy, Robert C.; Iwashyna, Theodore J.

doi:10.1016/j.jcrc.2017.09.180

Cited by 49 publications

(54 citation statements)

References 28 publications

(32 reference statements)

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“…In the remaining survey items, we asked about team composition in ABCDE delivery as well as perception of SMMs using items from the previously validated Team Survey [22][23]. The final survey was pilot tested with a small set of practicing ICU clinicians and researchers (1 nurse researcher, 5 ICU physician researchers) for flow and clarity as previously done [23]. The pilot testing process involved completing the survey, and reviewing all items for clarity, consistency and flow.…”

Section: Designmentioning

confidence: 99%

Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation

Boltey

Iwashyna

Hyzy

et al. 2019

Journal of Critical Care

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Purpose: Poor coordination may impede delivery of the Awakening, Breathing Coordination, Delirium monitoring/management and Early exercise/mobility (ABCDE) bundle. Developing a shared mental model (SMM), where all team members are on the same page, may support coordination. Materials and Methods: We administered a survey at the 2016 MHA Keystone Center ICU workshop. We measured different components of SMMs using five items from a validated survey, each on a 5-point Likert scale (strongly agree-strongly disagree). We measured self-reported routine ABCDE implementation using a single item 4-point Likert scale (ABCDE is routine-Made no steps to implement ABCDE). We examined the relationship between SMMs and routine ABCDE implementation using logistic regression, adjusting for confounders. Results: Among the 206 (75%) responses, 157 (84%) reported using the ABCDE bundle and 80 (51% of 157) reported routine use. When clinicians agreed it was difficult to predict team members' behaviors, the odds of reporting routine ABCDE implementation significantly decreased [0.26 (0.10-0.66)]. Other SMM components related to knowing team members' skills, access to information, team adaptability, and team help behavior, were not significantly associated with the outcome. Conclusion: Increasing awareness of team members' behaviors may be a mechanism to improve the implementation of complex care bundles like ABCDE.

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Section: Designmentioning

confidence: 99%

Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation

Boltey

Iwashyna

Hyzy

et al. 2019

Journal of Critical Care

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“…There is less opportunity to foster a community among team members. In the ICU, where care provided by a diverse interprofessional team is vital to high-quality patient care (12), the absence of such community can have many consequences, including to affect the clinicians' ability to manage emotions and symptoms of psychological distress. Focusing on strategies to manage the emotions before they progress is one key way to help develop a supportive community for individuals, interprofessional teams, and healthcare systems.…”

Section: Steps Forwardmentioning

confidence: 99%

The Cost of Caring: Emotion, Burnout, and Psychological Distress in Critical Care Clinicians

Costa¹,

Moss

2018

Annals ATS

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“…Bedside nurses are central to the identification, prevention, and treatment of delirium (Balas et al, 2012;Costa et al, 2018). As a constant bedside presence, nurses are best able to identify the fluctuating mental status central to delirium diagnosis.…”

Section: Relevance To Clinical Practicementioning

confidence: 99%

“…Nurses are key to coordinated communication and care among the various teams responsible for the critically ill patient, including the medical team, respiratory therapy, and physical therapy (Balas et al, 2013). In fact, nurse involvement in delirium prevention activities significantly increases the odds of intervention implementation (Costa et al, 2018), highlighting the crucial role of the bedside nurse in delirium care.…”

Section: Relevance To Clinical Practicementioning

confidence: 99%

The Life Course Health Development Model: A theoretical research framework for paediatric delirium

Kalvas

2019

Journal of Clinical Nursing

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Aims and Objectives: The purpose of this article is to create a framework for future research through application and critique of the Life Course Health Development Model to the phenomenon of pediatric delirium. Background: Delirium in the pediatric intensive care unit is associated with increased duration of mechanical ventilation, length of stay, and mortality. Nurses are uniquely positioned at the bedside to identify, prevent, and treat delirium. An understanding of the potential long-term consequences of pediatric delirium is necessary to provide impetus for nursing research and practice change. The Life Course Health Development Model is a valuable tool when considering the multiple mechanisms and processes through which the experience of delirium could affect a child's life trajectory. Design: Critical review of the literature through application and critique of the Life Course Health Development Model in the context of pediatric delirium. Gaps in the current understanding of pediatric delirium, as well as future directions for research and practice, are discussed. Methods: The seven core principles of the model are considered in the context of pediatric delirium. Each of the principles has the potential to further understanding of pediatric delirium and identify areas for future inquiry. This discussion leads to a critique of the ability of the model to lead future research and practice change. Conclusions: The Life Course Health Development Model depicts a process in which the acute and severe stress of critical illness leads to maladaptive neurologic changes that contribute to the development of delirium and impair a child's life trajectory. Relevance to Clinical Practice: By emphasizing the potential lifelong consequences for critically ill children who experience delirium, this application of the Life Course Health Development Model will stimulate discussion, research, and practice change among pediatric clinicians and researchers.

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ICU team composition and its association with ABCDE implementation in a quality collaborative

Abstract: ABCDE implementation was associated with frequent involvement of team members, suggesting a need for role articulation and coordination.

Cited by 49 publications

References 28 publications

Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation

Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation

The Cost of Caring: Emotion, Burnout, and Psychological Distress in Critical Care Clinicians

The Life Course Health Development Model: A theoretical research framework for paediatric delirium

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